Epidemiology of Weaning Outcome according to a New Definition. The WIND Study

Gaëtan Béduneau, Tài Pham, Frédérique Schortgen, et al.

Am J Respir Crit Care Med 2017; 195: 772-783

Rationale: 背景

The weaning process concerns all patients receiving mechanical ventilation. A previous classification into simple, prolonged, and difficult weaning ignored weaning failure and presupposed the use of spontaneous breathing trials.

脱机过程涉及所有接受机械通气的患者。既往分类方法将患者分为简单脱机、延迟脱机及困难脱机，这种分类方法不考虑脱机失败，主张使用自主呼吸试验。

Objectives: 目的

To describe the weaning process, defined as starting with any attempt at separation from mechanical ventilation and its prognosis, according to a new operational classification working for all patients under ventilation.

根据新的操作定义描述脱机过程（即从脱离机械通气的任何尝试开始）及其预后。

Methods: 方法

This was a multinational prospective multicenter observational study over 3 months of all patients receiving mechanical ventilation in 36 intensive care units, with daily collection of ventilation and weaning modalities. Pragmatic definitions of separation attempt and weaning success allowed us to allocate patients in four groups.

这是一项多个国家前瞻多中心观察性研究，历时3个月，入选了36个ICU中接受机械通气的所有患者，每日收集通气及脱机指标。根据有关脱机尝试及脱机成功的实用定义，我们将患者分为4个组。

Measurements and Main Results: 预后指标与主要结果

A total of 2,729 patients were enrolled. Although half of them could not be classified using the previous definition, 99% entered the groups on the basis of our new definition as follows: 24% never started a weaning process, 57% had a weaning process of less than 24 hours (group 1), 10% had a difficult weaning of more than 1 day and less than 1 week (group 2), and 9% had a prolonged weaning duration of 1 week or more (group 3). Duration of ventilation, intensive care unit stay, and mortality (6, 17, and 29% for the three groups, respectively) all significantly increased from one group to the next. The unadjusted risk of dying was 19% after the first separation attempt and increased to 37% after 10 days.

共入选2729名患者。根据既往定义，近半数患者无法分类。但根据新的定义，99%的患者分组如下：24%的患者从未开始脱机过程，57%的患者24小时内开始脱机（第一组），10%的患者为困难脱机，即一天至一周之间（第二组），9%的患者为延迟脱机，即一周以上脱机（第三组）。从第一组到第三组，机械通气时间、ICU住院日及病死率（三组患者分别为6%，17%和29%）均显著增加。首次脱机尝试后未校正死亡风险为19%，10天后增加到37%。

Conclusions: 结论

A new classification allows us to categorize all weaning situations. Every additional day without a weaning success after the first separation attempt increases the risk of dying.

新的分类使得我们能够对所有脱机情况进行分类。在首次脱机尝试后，脱机不成功每增加一天，死亡风险也相应增加。