tailieunhanh - Báo cáo y học: "Routine use of weaning predictors: not so fast"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Routine use of weaning predictors: not so fast. | Available online http content 13 5 197 Commentary Routine use of weaning predictors not so fast Scott K Epstein Office of Educational Affairs Tufts University School of Medicine 145 Harrison Avenue Room 317 Boston MA 02111 USA Corresponding author Scott K Epstein Published 21 October 2009 This article is online at http content 13 5 197 2009 BioMed Central Ltd Critical Care 2009 13 197 doi cc8121 See related research by Nemer et al. http content 13 5 R152 Abstract Weaning from mechanical ventilation remains a major challenge for critical care physicians. Because subjective criteria are inaccurate objective measurements consisting of clinical criteria and physiologic tests weaning predictors have been used to facilitate decision-making. An integrated weaning index calculated as the product of static compliance and arterial oxygen saturation divided by the frequency-tidal volume ratio appears to be more accurate than other currently available predictors. Despite the accuracy of this new test a beneficial effect on outcome is yet to be proven. Invasive mechanical ventilation provides support during recovery from acute respiratory failure but results in complications and longer duration of intubation is associated with increased mortality. Patients should therefore be weaned and extubated as soon as it is safe to do so. Objective physiologic measurements weaning predictors are often used as surrogate markers of recovery 1 . Unfortunately an evidence-based review identified relatively few predictors associated with clinically significant changes in the probability of weaning success or failure 2 . Of the predictors studied the respiratory frequency to tidal volume ratio f VT appears to be most accurate 3 . Because weaning failure often results from a complex interplay of factors a more comprehensive integrative index may prove superior. Milic-Emili first proposed an inspiratory effort quotient to predict