一位利用每分鐘通氣量恢復時間預測呼吸器脫離之經驗

呼吸器脫離是急性呼吸衰竭使用呼吸器的病人很重要之議題，慢性阻塞性肺疾病病人之急性惡化多由感染所導致，亦是造成臨床上呼吸器脫離過程延長的原因之一。本文藉由臨床呼吸照護經驗，就慢性阻塞性肺疾病急性惡化（Chronic obstructive pulmonary disease acute exacerbation ;COPDAE）的病人，探討利用每分鐘通氣量恢復時間（Minute ventilation recovery time; MVRT）之呼吸器脫離新指標，進行預測呼吸器脫離與拔除人工氣管插管之時機。MVRT是一種在T型管自然呼吸試驗下，一系列測量每分鐘通氣量的分析，其原始方法如下：（1）在T型管訓練前24小時中所測量到的穩定最低值；（2）以此點作為基準值接回呼吸器；（3）計算回到基準值之110％所花時間；（4）若時間小於15分鐘，便可預測此病人能成功脫離呼吸器。此經驗以提供呼吸治療師對於COPDAE選用最適合的呼吸器脫離時機與訓練之參考。

關鍵字

呼吸器脫離；慢性阻塞性肺疾病急性惡化；每分鐘通氣量恢復時間

並列摘要

Successful discontinuation of mechanical ventilator is a critical issue on patient using ventilator due to acute respiratory failure. Infection is the most common cause of an acute exacerbation of chronic obstructive pulmonary disease (COPDAE), which often leads a prolonged ventilator weaning. By using minute ventilation recovery time (MVRT) as an indicator, we tried to predict the best timing for weaning from mechanical ventilator and extubation on a patient with COPDAE. MVRT is defined as the time required for minute ventilation to return to baseline following a successful spontaneous breathing trial. The method we used included the following steps: (1) defining the baseline of minute ventilation by using the lowest value retrieved during the prior 24 hours, (2) using a T-tube to perform the spontaneous breathing trial, and (3) measuring the time of minute ventilation returning to 110% of the baseline. If the time is less than 15 minutes, a successful discontinuation of mechanical ventilator could be expected. We provide our experience of using MVRT as an indicator for prediction of successful weaning from ventilator on a COPDAE case.

並列關鍵字

discontinuation of ventilator ； acute exacerbation of COPD ； minute ventilation recovery time

國際替代計量

一位利用每分鐘通氣量恢復時間預測呼吸器脫離之經驗

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