Smartcare等通气模式对慢性阻塞性肺病患者呼吸力学的影响
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摘要
目的 (1) 通过分析潮气呼吸流速-容积曲线、二氧化碳时间曲线以及二氧化碳容量曲线参数,了解间歇正压通气(IPPV)、双相气道正压通气(BIPAP)和自动变流(autoflow)模式对慢性阻塞性肺病(COPD)患者呼吸力学的影响。(2) 通过改变压力上升速度,了解对压力支持通气(PSV)呼吸力学参数和吸呼切换的影响。(3) 通过比较PSV模式联合自动插管补偿(ATC)前后的呼吸力学参数,了解PSV+ATC是否优于PSV模式。(4) 通过比较Smartcare脱机模式和间断停用呼吸机两种脱机方法,了解Smartcare脱机模式是否可以提高COPD患者的脱机成功率。
方法 (1) 对21例处于稳定期的老年COPD患者进行IPPV、BIPAP和autodlow通气治疗,比较不同通气模式对呼吸力学参数的影响。(2) 对19例COPD患者使用PSV模式进行通气治疗,比较改变压力上升速度以及使用ATC前后对呼吸力学参数的影响。(3) 38例COPD患者随机分为Smartcare脱机组和间断停用呼吸机组,进行脱机治疗。
结果 (1) COPD患者的内源性呼气末正压与呼气峰夹角和呼气末流速明显相关。(2) BIPAP和autoflow模式可以降低气道压,增加肺动态顺应性,使死腔增大。(3) 压力上升速度越快,COPD患者在PSV模式时吸气肌用力越小。(4) 压力上升速度大小与PSV模式的吸呼切换同步与否无关。(5) PSV+ATC会增加无效触发呼吸次数,同时使高潮气量报警次数增多。(6) Smartcare脱机模式的7天脱机成功率高于间断停用呼吸机的脱机方法。
结论 (1) BIPAP和autoflow模式时宜提高吸气流速,增加气体弥散,减少死腔。(2) 对于老年COPD患者,使用Ramp0.2的压力上升速度较好。(3)PSV+ATC模式不适用于COPD患者。(4) Smartcare脱机模式在7天内的脱机成功率优于间断停用呼吸机的脱机方法。
Objectives (1).To compare the respiratory mechanics of intermittent positive pressure ventilation(IPPV),biphasic-positive airway pressure(BIPAP) and autoflow by analysis parameters of Flow-volume curves , time capnogram and volumetric capnography. (2). To evaluate the effects of pressure ramp slop values on respiratory mechanics and inspiration termination criteria during pressure support ventilation(PSV).(3).To assess the respiratory mechanic of PSV with and without automatic tube compensation in ventilating patients with COPD . (4). To compare the outcome of the Smartcare and spontaneous breathing trails (SBT) for weaning patients with COPD.Methods (1). 21 patients with COPD were treated with IPPV ,BIPAP and autoflow.Parameters of resoiratory mechanics were recorded.(2).19 patients with COPD were treated with PSV . Parameters of resoiratory mechanics were recorded. (3). 38 patients with COPD were weaned with Smartcare and SBT.Results (1)The intrinsic positive end-expiratory pressure (PEEPi) in COPD is associated with the angle of peak expiratory flow and the end flow of expiratory. (2). BIPAP and autoflow can decrease the tracheal air pressure,improve the dynamic compliance of lung and increase the dead space .(3).The rapid of pressurization may decrease the inspiratory effort during pressure support ventilation in COPD patients. (4)The pressure ramp slop values has no effects on inspiration termination criteria during PSV. (5) PSV and ATC may increase the numbers of no-effective trigger and the numbers of high volume limited warning. (6)The Smartcare is better than SBT in weaning COPD men within 7 days.
方法 (1) 对21例处于稳定期的老年COPD患者进行IPPV、BIPAP和autodlow通气治疗,比较不同通气模式对呼吸力学参数的影响。(2) 对19例COPD患者使用PSV模式进行通气治疗,比较改变压力上升速度以及使用ATC前后对呼吸力学参数的影响。(3) 38例COPD患者随机分为Smartcare脱机组和间断停用呼吸机组,进行脱机治疗。
结果 (1) COPD患者的内源性呼气末正压与呼气峰夹角和呼气末流速明显相关。(2) BIPAP和autoflow模式可以降低气道压,增加肺动态顺应性,使死腔增大。(3) 压力上升速度越快,COPD患者在PSV模式时吸气肌用力越小。(4) 压力上升速度大小与PSV模式的吸呼切换同步与否无关。(5) PSV+ATC会增加无效触发呼吸次数,同时使高潮气量报警次数增多。(6) Smartcare脱机模式的7天脱机成功率高于间断停用呼吸机的脱机方法。
结论 (1) BIPAP和autoflow模式时宜提高吸气流速,增加气体弥散,减少死腔。(2) 对于老年COPD患者,使用Ramp0.2的压力上升速度较好。(3)PSV+ATC模式不适用于COPD患者。(4) Smartcare脱机模式在7天内的脱机成功率优于间断停用呼吸机的脱机方法。
Objectives (1).To compare the respiratory mechanics of intermittent positive pressure ventilation(IPPV),biphasic-positive airway pressure(BIPAP) and autoflow by analysis parameters of Flow-volume curves , time capnogram and volumetric capnography. (2). To evaluate the effects of pressure ramp slop values on respiratory mechanics and inspiration termination criteria during pressure support ventilation(PSV).(3).To assess the respiratory mechanic of PSV with and without automatic tube compensation in ventilating patients with COPD . (4). To compare the outcome of the Smartcare and spontaneous breathing trails (SBT) for weaning patients with COPD.Methods (1). 21 patients with COPD were treated with IPPV ,BIPAP and autoflow.Parameters of resoiratory mechanics were recorded.(2).19 patients with COPD were treated with PSV . Parameters of resoiratory mechanics were recorded. (3). 38 patients with COPD were weaned with Smartcare and SBT.Results (1)The intrinsic positive end-expiratory pressure (PEEPi) in COPD is associated with the angle of peak expiratory flow and the end flow of expiratory. (2). BIPAP and autoflow can decrease the tracheal air pressure,improve the dynamic compliance of lung and increase the dead space .(3).The rapid of pressurization may decrease the inspiratory effort during pressure support ventilation in COPD patients. (4)The pressure ramp slop values has no effects on inspiration termination criteria during PSV. (5) PSV and ATC may increase the numbers of no-effective trigger and the numbers of high volume limited warning. (6)The Smartcare is better than SBT in weaning COPD men within 7 days.
引文
[1] Yang SC, Yang SP. Effects of inspiratory flow waveforms on lung mechanics, gas exchange and respiratory metabolism in COPD patients during mechanical ventilation. Chest.2002, 122(6):2096-104
[2] Laghi F, Segal J, Choe WK, et al. Effeet of imposed inflation time on respiratory frequency and hyperinflation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001,163(6): 1365-70.
[3] Bonmarchand G, Chevron V, Chopin C,et al.Increased initial flow rate reduces inspiratory work of breathing during pressure support ventilation in patients with exacerbation of chronic obstructive pulmonary disease. Intensive Care Med. 1996;22(11): 1147-54.
[4] Chiumello D, Pelosi P, Croci M, et al.The effects of pressurization rate on breathing pattern, work of breathing, gas exchange and patient comfort in pressure support ventilation. Eur Respir J.2001; 18(1): 107-14.
[5] Guttmann J, Haberthur C,Mols C, Automatic tube compensation. Respir Care Clin N Am.2001; 7(3):475-501.
[6] Capdevila,-X;Perrigault,-P-F;Ramonatxo,-M;et al.Changes in breathing pattern and respiratory muscle performance parameters during difficult weaning. Crit Care Med. 1998;26(1):79-85.
[7] 俞森洋,主编.现代机械通气的监护和临床应用.北京:中国协和医科大学出版社,2002;58—59。
[8] Guttmann J, Eberhard L, Fabry B, et al. Time contant/volume relationship of passive expiration in mechanically ventilated ARDS patients. Eur Respir J.1995;8(1):114-20.
[9] Aerts JG, van-den-Berg B, Lourens MS, et al. Expiratory Flow-volume curves in mechanically ventilated patients with chronic obstructive pulmonary disease. Acta Anaesthesiol Scand. 1999;43(3):322-7.
[10] Romero PV, Lucangelo U ,Lopez-Aguilar J,et al.PhysioUgically based indices of volumetric capnography in patients receiving mechanical ventilation. Eur RespirJ.1997;10(6):1309-15.
[1 1]Lourens MS, van-den-Berg B, Hoogsteden HC, et al.Flow-volume curves as measurement of respiratory mechanics during ventilatory support:the effect of the exhalation value. Intensive Care Med.l999;25(8):799-804.
[12]De-Chazal I, Hubmayr RD.Novel aspects of pulmonary mechanics in intensive care.Br J Anaesth.2003; 91(1):81-91.
[13]Armaganidis A,Stavrakaki-Kallergi K,Koutsoukou A,et al.Intrinsic positive end-expiratory pressure in mechanically ventilated patients with and without tidal expiratory flow limitation.Crit Care Med.2000;28(12):3837-42.
[14]Lourens MS, van-der-Berg B, Aerts JG, et al.Expiratory time constants in mechanically ventilated patients with and without COPD. Intensive Care Med.2000;26(11):1612-8.
[15]Bardoczky GI, dHollander AA, Cappello M, et al.Interrupted expiratory flow on automatically constructed flow-volume curves may determine the pressure of intrinsic positive end-expiratory pressure during one-lung ventilation. Anesth Analg.l998;86:880-4.
[16]Fernandez-Mondejar E,Vazquez-Mata G, Navarrete-Navarro P, et al.Increase in Lung volume originated by extrinsic PEEP in patients with auto-PEEP. The role of static lung compliance. Intensive Care Med.1992;18(5):269-73.
[17]Morley TF, Giaimo J, Maroszan E, et al. Use of capnography for assessment of the adequacy of alveolar ventilation during weaning from mechanical ventilation. Am Rev Respir Dis.l993;148(2):339-43.
[18] Blanch L, Fernandez R, Saura P, etal.Relationship between expired capnogram and respiratory system resistance in critically ill patients during total ventilatory support. Chest.l994;105(1):219-23.
[19]Flelcher R, Jonson B.Deadspace and the single breath test for carbon dioxide
during anaesthesia and artificial ventilation. Br J Anaesth.1984;56:109-19.
[20] Yaron M, Padyk P, Hutsinpiller M, etal.Utility of the expiratory capnogram in the assessment of bronchospasm.Ann Emerg Med.1996;28(4):403-7.
[21]Putensen C Rasanen J ,Lopez FA. Ventilation-perfusion distribtions during mechanical ventilation with superimposed spontaneous breathing in canine lung injury. Am J Respir Crit Care Med.l994;150(l):101-8.
[22]Henzler D ,Dembinski R,Bensberg R,etal.Ventilation with biphasic positive airway pressure in experimental lung injury.Influence of transpulmonary pressure on gas exchang and haemodynamic.Intensive Care Med.2004,30(5):935-43.
[23] Fletcher R, Jonson B, Cumming G, et al .The concept of deadspace with special reference to the single breath test for carbon dioxide. Br J Anaesth.l981;53:77-87.
[24] Breen PH ,Mazumdar B.How does positive end-expiratory pressure decrease CO2 elimination from the lung? Respiration Physiology.1996;103:233-42.
[25]Yamada Y,Shigeta M,Suwa K,etal.Respiratory muscle pressure analysis in pressure-support ventilation. J Appl Pysiol.l994;77(5):2237-43.
[26] Iotti GA, Braschi A,Brunner JX, et al.Noninvasive evaluation of instantaneous total mechanical activity of the respiratory muscles during pressure support ventilation.Chest.l995;108(1):208-15.
[27]Giannouli E, Webster K,Roberts D,et al.Response of ventilator-dependent patients to different levels of pressure support and proportional assist. Am J Respir Crit Care Med.l999;159(6):1716-25.
[28]Kacmarek RM.NIPPV:patient-ventilator syschrony,the difference between success and failure? Intensive Care Med.l999;25(7):645-7.
[29]Chiumello D,Pelosi P,Taccone P,et al.Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury. Crit Care Med.2003;31(11):2604-10.
[30]Bonmarchand G,Chevron V,Chopin C,et al.Increased initial flow rate reduces inspiratory work of breathing during pressure support ventilation in patients with exacerbation of chronic obstructive pulmonary disease. Intensive Care Med.l996;22(11):1147-54.
[31]Bonmarchand G,Chevron V,Menard JF,et al.Effects of pressure ramp slope values on the work of breathing during pressure support ventilation in restrictive patients. Crit Care Med.l999;27(4):715-22.
[32]Berger KI,Sorkin IB,Norman RG,et al.Mechanism of relief of tachypnea during pressure support ventilation.Chest.l996;109(5):1320-7.
[33]Alberti A,Gallo F,Fongaro A,et al.PO.l is a useful parameter in setting the level of pressure support ventilation. Intensive Care Med.1995;21(7):547-53.
[34]Johannigman JA,Davis KJr,Campbell RS,et al.Use of the rapid/shallow breathing index as an indicator of patient work of breathing during pressure support ventilation.Surgery. 1997; 122(4):737-40.
[35]Yamada Y,Du HL.Analysis of the mechanisms of expiratory asynchrony in pressure support ventilation:a mathematical approach.J Appl Pysiol.2000;88(6):2143-50.
[36] Parthasarathy S,Jubran A,Tobin MJ.Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med.l998;158(4):1471-78.
[37]Chatmongkolchart S,Williams P,Hess DR,et aI.Evaluation of inspiratory rise time and inspiration termination criteria in new-generation mechanical ventilators:a lung model study.Respiratory care.2001;46(7):666-677.
[38]Breen PH, Jacobsen BP.Carban dioxide spirogram (but not capnogram) detects leaking inspiratory valve in a circle circuit. Anesth Analg.l997;85(6):1372-6.
[39]Haberthur C,Mols G, Elsasser S,et al.Extubation after breathing trials with automatic tube compensation,T-tube ,or pressure support ventilation. Acta
Anaesthesiol Scand.2002;46(8):973-80.
[40]Mols G,Rohr E,Benzing A,et al.Breathing pattern associated with respiratory comfort during automatic tube compensation and pressure support ventilation in normal subjects. Acta Anaesthesiol Scand.2000;44(3):223-30.
[41]Tsuno K,Miura K,Takeya M,et al.Histopathologic pulmonary changes from mechanical ventilation at high peak airway pressures. Am J Respir Crit Care Med.l991;143(5Ptl):1115-20.
[42]MacIntyre NR.Evidence-based guidelines for weaning and discontinuing ventilatory support. Chest.2001;120(6Suppl):375s-395s.
[43]Vitacca,-M;Vianello,-A;Colombo,-D;et al. Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days.Am J Respir Crit Care Med.2001;164(2):225-30
[44]Brochard,-L;Rauss,-A;Benito,-S;etal. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med.1994;150(4):896-903.
[45]Sulzer,-C-F;Chiolero,-R;Chassot,-P-G;et al.Adaptive support ventilation for fast tracheal extubation after cardiac surgery:a randomized controlled study. Anaesthesiology.2001 ;95(6): 1339-45
[46] Petter,-A-H;Chiolero,-R-L;Cassina,-T;Automatic "respirator/weaning" with adaptive support ventilation:the effect on duration of endotracheal intubation and patient management.Anesth Analg.2003;97(6): 1743-50.
[47]Cassina T, Chiolero R, Mauri R, et al. Clinical experience with adaptive support ventilation for fast-track cardiac surgery.J Cardiothorac Vasc Anesth.2003;17(5):571-5.
[48]Jubran A, Tobin MJ.Pathophysiologic basis of acute respiratory distress in patients who fail a trail of weaning from mechanical ventilation. Am J Respir Crit Care Med.l997;155(3):906-15.
[2] Laghi F, Segal J, Choe WK, et al. Effeet of imposed inflation time on respiratory frequency and hyperinflation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001,163(6): 1365-70.
[3] Bonmarchand G, Chevron V, Chopin C,et al.Increased initial flow rate reduces inspiratory work of breathing during pressure support ventilation in patients with exacerbation of chronic obstructive pulmonary disease. Intensive Care Med. 1996;22(11): 1147-54.
[4] Chiumello D, Pelosi P, Croci M, et al.The effects of pressurization rate on breathing pattern, work of breathing, gas exchange and patient comfort in pressure support ventilation. Eur Respir J.2001; 18(1): 107-14.
[5] Guttmann J, Haberthur C,Mols C, Automatic tube compensation. Respir Care Clin N Am.2001; 7(3):475-501.
[6] Capdevila,-X;Perrigault,-P-F;Ramonatxo,-M;et al.Changes in breathing pattern and respiratory muscle performance parameters during difficult weaning. Crit Care Med. 1998;26(1):79-85.
[7] 俞森洋,主编.现代机械通气的监护和临床应用.北京:中国协和医科大学出版社,2002;58—59。
[8] Guttmann J, Eberhard L, Fabry B, et al. Time contant/volume relationship of passive expiration in mechanically ventilated ARDS patients. Eur Respir J.1995;8(1):114-20.
[9] Aerts JG, van-den-Berg B, Lourens MS, et al. Expiratory Flow-volume curves in mechanically ventilated patients with chronic obstructive pulmonary disease. Acta Anaesthesiol Scand. 1999;43(3):322-7.
[10] Romero PV, Lucangelo U ,Lopez-Aguilar J,et al.PhysioUgically based indices of volumetric capnography in patients receiving mechanical ventilation. Eur RespirJ.1997;10(6):1309-15.
[1 1]Lourens MS, van-den-Berg B, Hoogsteden HC, et al.Flow-volume curves as measurement of respiratory mechanics during ventilatory support:the effect of the exhalation value. Intensive Care Med.l999;25(8):799-804.
[12]De-Chazal I, Hubmayr RD.Novel aspects of pulmonary mechanics in intensive care.Br J Anaesth.2003; 91(1):81-91.
[13]Armaganidis A,Stavrakaki-Kallergi K,Koutsoukou A,et al.Intrinsic positive end-expiratory pressure in mechanically ventilated patients with and without tidal expiratory flow limitation.Crit Care Med.2000;28(12):3837-42.
[14]Lourens MS, van-der-Berg B, Aerts JG, et al.Expiratory time constants in mechanically ventilated patients with and without COPD. Intensive Care Med.2000;26(11):1612-8.
[15]Bardoczky GI, dHollander AA, Cappello M, et al.Interrupted expiratory flow on automatically constructed flow-volume curves may determine the pressure of intrinsic positive end-expiratory pressure during one-lung ventilation. Anesth Analg.l998;86:880-4.
[16]Fernandez-Mondejar E,Vazquez-Mata G, Navarrete-Navarro P, et al.Increase in Lung volume originated by extrinsic PEEP in patients with auto-PEEP. The role of static lung compliance. Intensive Care Med.1992;18(5):269-73.
[17]Morley TF, Giaimo J, Maroszan E, et al. Use of capnography for assessment of the adequacy of alveolar ventilation during weaning from mechanical ventilation. Am Rev Respir Dis.l993;148(2):339-43.
[18] Blanch L, Fernandez R, Saura P, etal.Relationship between expired capnogram and respiratory system resistance in critically ill patients during total ventilatory support. Chest.l994;105(1):219-23.
[19]Flelcher R, Jonson B.Deadspace and the single breath test for carbon dioxide
during anaesthesia and artificial ventilation. Br J Anaesth.1984;56:109-19.
[20] Yaron M, Padyk P, Hutsinpiller M, etal.Utility of the expiratory capnogram in the assessment of bronchospasm.Ann Emerg Med.1996;28(4):403-7.
[21]Putensen C Rasanen J ,Lopez FA. Ventilation-perfusion distribtions during mechanical ventilation with superimposed spontaneous breathing in canine lung injury. Am J Respir Crit Care Med.l994;150(l):101-8.
[22]Henzler D ,Dembinski R,Bensberg R,etal.Ventilation with biphasic positive airway pressure in experimental lung injury.Influence of transpulmonary pressure on gas exchang and haemodynamic.Intensive Care Med.2004,30(5):935-43.
[23] Fletcher R, Jonson B, Cumming G, et al .The concept of deadspace with special reference to the single breath test for carbon dioxide. Br J Anaesth.l981;53:77-87.
[24] Breen PH ,Mazumdar B.How does positive end-expiratory pressure decrease CO2 elimination from the lung? Respiration Physiology.1996;103:233-42.
[25]Yamada Y,Shigeta M,Suwa K,etal.Respiratory muscle pressure analysis in pressure-support ventilation. J Appl Pysiol.l994;77(5):2237-43.
[26] Iotti GA, Braschi A,Brunner JX, et al.Noninvasive evaluation of instantaneous total mechanical activity of the respiratory muscles during pressure support ventilation.Chest.l995;108(1):208-15.
[27]Giannouli E, Webster K,Roberts D,et al.Response of ventilator-dependent patients to different levels of pressure support and proportional assist. Am J Respir Crit Care Med.l999;159(6):1716-25.
[28]Kacmarek RM.NIPPV:patient-ventilator syschrony,the difference between success and failure? Intensive Care Med.l999;25(7):645-7.
[29]Chiumello D,Pelosi P,Taccone P,et al.Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury. Crit Care Med.2003;31(11):2604-10.
[30]Bonmarchand G,Chevron V,Chopin C,et al.Increased initial flow rate reduces inspiratory work of breathing during pressure support ventilation in patients with exacerbation of chronic obstructive pulmonary disease. Intensive Care Med.l996;22(11):1147-54.
[31]Bonmarchand G,Chevron V,Menard JF,et al.Effects of pressure ramp slope values on the work of breathing during pressure support ventilation in restrictive patients. Crit Care Med.l999;27(4):715-22.
[32]Berger KI,Sorkin IB,Norman RG,et al.Mechanism of relief of tachypnea during pressure support ventilation.Chest.l996;109(5):1320-7.
[33]Alberti A,Gallo F,Fongaro A,et al.PO.l is a useful parameter in setting the level of pressure support ventilation. Intensive Care Med.1995;21(7):547-53.
[34]Johannigman JA,Davis KJr,Campbell RS,et al.Use of the rapid/shallow breathing index as an indicator of patient work of breathing during pressure support ventilation.Surgery. 1997; 122(4):737-40.
[35]Yamada Y,Du HL.Analysis of the mechanisms of expiratory asynchrony in pressure support ventilation:a mathematical approach.J Appl Pysiol.2000;88(6):2143-50.
[36] Parthasarathy S,Jubran A,Tobin MJ.Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med.l998;158(4):1471-78.
[37]Chatmongkolchart S,Williams P,Hess DR,et aI.Evaluation of inspiratory rise time and inspiration termination criteria in new-generation mechanical ventilators:a lung model study.Respiratory care.2001;46(7):666-677.
[38]Breen PH, Jacobsen BP.Carban dioxide spirogram (but not capnogram) detects leaking inspiratory valve in a circle circuit. Anesth Analg.l997;85(6):1372-6.
[39]Haberthur C,Mols G, Elsasser S,et al.Extubation after breathing trials with automatic tube compensation,T-tube ,or pressure support ventilation. Acta
Anaesthesiol Scand.2002;46(8):973-80.
[40]Mols G,Rohr E,Benzing A,et al.Breathing pattern associated with respiratory comfort during automatic tube compensation and pressure support ventilation in normal subjects. Acta Anaesthesiol Scand.2000;44(3):223-30.
[41]Tsuno K,Miura K,Takeya M,et al.Histopathologic pulmonary changes from mechanical ventilation at high peak airway pressures. Am J Respir Crit Care Med.l991;143(5Ptl):1115-20.
[42]MacIntyre NR.Evidence-based guidelines for weaning and discontinuing ventilatory support. Chest.2001;120(6Suppl):375s-395s.
[43]Vitacca,-M;Vianello,-A;Colombo,-D;et al. Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days.Am J Respir Crit Care Med.2001;164(2):225-30
[44]Brochard,-L;Rauss,-A;Benito,-S;etal. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med.1994;150(4):896-903.
[45]Sulzer,-C-F;Chiolero,-R;Chassot,-P-G;et al.Adaptive support ventilation for fast tracheal extubation after cardiac surgery:a randomized controlled study. Anaesthesiology.2001 ;95(6): 1339-45
[46] Petter,-A-H;Chiolero,-R-L;Cassina,-T;Automatic "respirator/weaning" with adaptive support ventilation:the effect on duration of endotracheal intubation and patient management.Anesth Analg.2003;97(6): 1743-50.
[47]Cassina T, Chiolero R, Mauri R, et al. Clinical experience with adaptive support ventilation for fast-track cardiac surgery.J Cardiothorac Vasc Anesth.2003;17(5):571-5.
[48]Jubran A, Tobin MJ.Pathophysiologic basis of acute respiratory distress in patients who fail a trail of weaning from mechanical ventilation. Am J Respir Crit Care Med.l997;155(3):906-15.