每日一题_2022.5.16

A 36-year-old man was injured in a high-speed motor vehicle accident. He was unbelted and, as a result, was ejected from the vehicle. On arrival in the trauma bay, his Glasgow Coma Scale (GCS) score is 7, and he is emergently intubated. Injuries include a moderate subdural hematoma and subarachnoid hemorrhage, as well as diffuse axonal injury, multiple bilateral nondisplaced rib fractures, bilateral pulmonary contusions, grade 3 splenic injury managed nonoperatively, and left femur fracture managed with an intramedullary rod on post-trauma day six. On post-trauma day nine, his GCS score is 11T, and he qualifies for extubation.

Which of the following criteria for extubation is best supported by literature?

A. Negative inspiratory force

B. Vital capacity

C. Successful 30-minute spontaneous breathing trial 

D. Cuff leak

E. Muscle strength

答案解析：

文献支持最多的选择是成功的自主呼吸试验(SBT)。在美国，每年约有80万患者因不同病因的急性呼吸衰竭需要机械通气。一旦导致插管的所有炎症、代谢、创伤或感染状况均得到解决，患者应在拔管前过渡到SBT。有研究表明，ICU方案驱动的拔管缩短了通气天数。要使SBT成功，患者必须在很少或没有呼吸机支持的情况下自主呼吸至少30 min，没有呼吸急促（呼吸率大于35次/分钟），没有低于90%的氧饱和度下降，心率低于140次/分钟，收缩压波动不超过180或小于90 mmHg，无焦虑，无出汗。如果这是成功的，患者应该能够在没有过多分泌物的情况下保护气道。所有其他选项虽然有用，但本身并没有文献支持。

正确答案：C

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