Chinese Journal of Emergency and Critical Care Nursing >
A review on mechanical ventilation withdrawal nursing for obese patients in ICU
Due to the special pathophysiological structure of obese patients in ICU，difficulties in mechanical ventilation weaning and an increased risk of secondary intubation after weaning often occur，presenting considerable challenges to airway management. Professional clinical judgment，appropriate timing for weaning，and optimized weaning strategies are key to successful weaning of obese patients. Currently，there is limited research on weaning care for obese patients with mechanical ventilation in ICU in China. This article aims to review the factors affecting weaning in obese patients with mechanical ventilation in ICU，pre-weaning nursing assessment and preparation，weaning nursing strategies，and comprehensive post-weaning care，and provide a reference for weaning care of obese patients in ICU.
ZHOU Feifei , GAO Chunhua , CHU Junqing , LIN Yan , WANG Xiaohong , QIAO Wenbo , REN Yayu . A review on mechanical ventilation withdrawal nursing for obese patients in ICU[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025 , 6(5) : 636 -640 . DOI: 10.3761/j.issn.2096-7446.2025.05.023
| [1] | World Health Organization. Obesity[EB/OL].(2022-10-21)[2024-06-25]. https://www.who.int/health-topics/obesity#tab=tab_1. |
| [2] | 中华医学会健康管理学分会, 中国营养学会临床营养分会, 全国卫生产业企业管理协会医学营养产业分会, 等. 超重或肥胖人群体重管理流程的专家共识(2021年)[J]. 中华健康管理学杂志, 2021, 15(4):317-322. |
| Health Management Branch of Chinese Medical Association,Clinical Nutrition Branch of Chinese Nutrition Society, Medical Nutrition Industry Branch of National Health Industry Enter-prise Management Association, et al. Expert consensus on the procedure of body weight management among patients with overweight or obesity(2021)[J]. Chin J Health Manag, 2021, 15(4):317-322. | |
| [3] | 国家卫生健康委. 中国居民营养与慢性病状况报告(2020年)[J]. 营养学报, 2020, 42(6):521. |
| National Health Commission. Report on nutrition and chronic diseases of Chinese residents(2020)[J]. Acta Nutr Sin, 2020, 42(6):521. | |
| [4] | De Jong A, Verzilli D, Jaber S. ARDS in obese patients:speci-ficities and management[J]. Crit Care, 2019, 23(1):74. |
| [5] | Shao DA, Straub J, Matrka L. Obesity as a predictor of prolon-ged mechanical ventilation[J]. Otolaryngol Head Neck Surg, 2020, 163(4):750-754. |
| [6] | De Jong A, Capdevila M, Aarab Y, et al. Incidence,risk factors and long-term outcomes for extubation failure in intensive care unit in patients with obesity:a retrospective analysis of a multicenter prospective observational study[J]. Chest, 2024,8:S0012-3692. |
| [7] | Hirzallah FM, Alkaissi A, do Céu Barbieri-Figueiredo M. A sys-tematic review of nurse-led weaning protocol for mechani-cally ventilated adult patients[J]. Nurs Crit Care, 2019, 24(2):89-96. |
| [8] | 万磊, 薛富善. 肥胖患者的围术期气道管理和通气策略[J]. 中华实用诊断与治疗杂志, 2019, 33(10):943-947. |
| Wan L, Xue FS. Perioperative airway management and venti-lation strategy for obese patients[J]. J Chin Pract Diagn Ther, 2019, 33(10):943-947. | |
| [9] | 李志强, 王雅婧, 王红阳, 等. 肥胖对ICU机械通气患者住院死亡的影响研究[J]. 中国全科医学, 2017, 20(30):3749-3752,3758. |
| Li ZQ, Wang YJ, Wang HY, et al. Obesity and hospital morta-lity in mechanically ventilated ICU patients[J]. Chin Gen Pract, 2017, 20(30):3749-3752,3758. | |
| [10] | 杨荟晶, 吕慧颐, 杜婧, 等. 撤机困难影响因素及干预措施的研究进展[J]. 护理研究, 2024, 38(7):1237-1241. |
| Yang HJ, Lü HY, Du J, et al. Research progress on factors affecting difficult weaning and intervention measures[J]. Nurs Res, 2024, 38(7):1237-1241. | |
| [11] | Akella P, Voigt LP, Chawla S. To wean or not to wean:a prac-tical patient focused guide to ventilator weaning[J]. J Inten-sive Care Med, 2022, 37(11):1417-1425. |
| [12] | De Jong A, Wrigge H, Hedenstierna G, et al. How to ventilate obese patients in the ICU[J]. Intensive Care Med, 2020, 46(12):2423-2435. |
| [13] | Girard TD, Alhazzani W, Kress JP, et al. An official American thoracic society/american college of chest physicians clinical practice guideline:liberation from mechanical ventilation in critically ill adults. Rehabilitation protocols,ventilator libera-tion protocols,and cuff leak tests[J]. Am J Respir Crit Care Med, 2017, 195(1):120-133. |
| [14] | Chen YJ, Hwang SL, Li CR, et al. Vagal withdrawal and psy-chological distress during ventilator weaning and the related outcomes[J]. J Psychosom Res, 2017,101:10-16. |
| [15] | Spadaro S, Grasso S, Mauri T, et al. Can diaphragmatic ultra-sonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index[J]. Crit Care, 2016, 20(1):305. |
| [16] | 赵永华, 靳立振, 于巧青, 等. 膈肌超声检查在指导肥胖患者撤离呼吸机的预测价值研究[J]. 河北医学, 2021, 27(8):1363-1367. |
| Zhao YH, Jin LZ, Yu QQ, et al. The predictive value of diaphragmatic ultrasound for weaning from mechanical ven-tilation in obese patients[J]. Hebei Med, 2021, 27(8):1363-1367. | |
| [17] | 任宣霖, 樊落, 田金徽, 等. ICU气管插管患者拔管指南的质量评价与内容分析[J]. 中华护理杂志, 2022, 57(8):1001-1007. |
| Ren XL, Fan L, Tian JH, et al. Quality evaluation and content analysis of guidelines of airway extubation for adult patients in ICU[J]. Chin J Nurs, 2022, 57(8):1001-1007. | |
| [18] | de Jong A, Chanques G, Jaber S. Mechanical ventilation in obese ICU patients:from intubation to extubation[J]. Crit Care, 2017, 21(1):63. |
| [19] | Joffe A, Barnes CR. Extubation of the potentially difficult airway in the intensive care unit[J]. Curr Opin Anaesthesiol, 2022, 35(2):122-129. |
| [20] | 胡英莉, 蔡梦歆, 史冬雷. 机械通气患者拔管后吞咽障碍发生率及影响因素的Meta分析[J]. 中华现代护理杂志, 2019, 25(17):2158-2163. |
| Hu YL, Cai MX, Shi DL. Incidence and influencing factors of post-extubation dysphagia among patients with mechanical ventilation:a meta-analysis[J]. Chin J Mod Nurs, 2019, 25(17):2158-2163. | |
| [21] | Nascimento D, Carmona J, Mestre T, et al. Drooling rating sca-les in Parkinson’s disease:a systematic review[J]. Park Relat Disord, 2021,91:173-180. |
| [22] | 田翠杰, 王海播, 张文平, 等. 电阻抗断层成像技术在呼吸系统疾病中的临床应用[J]. 中国呼吸与危重监护杂志, 2020, 19(6):617-620. |
| Tian CJ, Wang HB, Zhang WP, et al. Clinical application of electrical impedance tomography in respiratory system diseases[J]. Chin J Respir Crit Care Med, 2020, 19(6):617-620. | |
| [23] | Rodrigues GC, Rocha NN, Maia LA, et al. Impact of experi-mental obesity on diaphragm structure,function,and bioener-getics[J]. J Appl Physiol, 2020, 129(5):1062-1074. |
| [24] | Osman AM, Hashim RM. Diaphragmatic and lung ultrasound application as new predictive indices for the weaning process in ICU patients[J]. Egypt J Radiol Nucl Med, 2017, 48(1):61-66. |
| [25] | Vorona S, Sabatini U, Al-Maqbali S, et al. Inspiratory muscle rehabilitation in critically ill adults. A systematic review and meta-analysis[J]. Ann Am Thorac Soc, 2018, 15(6):735-744. |
| [26] | 杨荟晶, 吕慧颐, 杜婧, 等. 撤机困难病人吸气肌训练的最佳证据总结[J]. 护理研究, 2023, 37(18):3287-3292. |
| Yang HJ, Lü HY, Du J, et al. Best evidence summary for inspiratory muscle training in patients with difficult weaning[J]. Chin Nurs Res, 2023, 37(18):3287-3292. | |
| [27] | 陈德友. 肥胖仰卧死亡综合征患者的护理[J]. 中华急危重症护理杂志, 2020, 1(4): 359-361. |
| Chen DY. Nursing care for patients with obesity hypoventila-tion syndrome[J]. Chin J Crit Care Nurs, 2020, 1(4):359-361. | |
| [28] | 李泳兴, 马武华. 困难气管拔管的预测因素及拔管策略的研究进展[J]. 国际麻醉学与复苏杂志, 2020, 41(5):488-492. |
| Li YX, Ma WH. Predictive factors and extubation strategies in difficult tracheal extubation[J]. Int J Anesthesiol Resusc, 2020, 41(5):488-492. | |
| [29] | 田晓艳, 陆娟, 詹静晔, 等. 重度肥胖伴呼吸机依赖患者成功脱机的护理[J]. 护士进修杂志, 2020, 35(2):145-148. |
| Tian XY, Lu J, Zhan JY, et al. Nursing care for successful weaning in patients with severe obesity and ventilator dependence[J]. J Nurs Train, 2020, 35(2):145-148. | |
| [30] | 周飞飞, 高春华, 林燕. Lemierre综合征患者机械通气撤机后继发声门闭合不全的护理[J]. 中华急危重症护理杂志, 2024, 5(1):47-50. |
| Zhou FF, Gao CH, Lin Y. Nursing care for patients with Le-mierre syndrome experiencing secondary vocal cord paralysis after mechanical ventilation weaning[J]. Chin J Crit Care Nurs, 2024, 5(1):47-50. | |
| [31] | 刘秀梅, 龚平, 康健, 等. 基于指南和RCT研究的ICU成人机械通气患者气管插管拔管管理的最佳证据总结[J]. 中华危重病急救医学, 2021, 33(8):927-932. |
| Liu XM, Gong P, Kang J, et al. Summary of the best evidence for the management of endotracheal intubation and extubation in adult mechanically ventilated patients in intensive care unit based on guidelines and randomized controlled trials[J]. Chin Crit Care Med, 2021, 33(8):927-932. | |
| [32] | Jagannathan N, Shivazad A, Kolan M. Tracheal extubation in children with difficult airways:a descriptive cohort analysis[J]. Paediatr Anaesth, 2016, 26(4):372-377. |
| [33] | Sonpeayung R, Tantisuwat A, Janwantanakul P, et al. Total and compartmental chest wall volumes,lung function,and respira-tory muscle strength in individuals with abdominal obesity:effects of body positions[J]. J Obes, 2019,2019:9539846. |
| [34] | Thille AW, Coudroy R, Nay MA, et al. High-wean study group and the Reva research network. Beneficial effects of noninva-sive ventilation after extubation in obese or overweight pa-tients:a post hoc analysis of a randomized clinical trial[J]. Am J Respir Crit Care Med, 2022, 205(4):440-449. |
| [35] | Hancu A, Mihal?an F. Obesity impact on respiratory function[J]. Intern Med, 2021, 18(1):41-58. |
| [36] | 杨雪凝, 李雪儿, 王松, 等. 慢性阻塞性肺疾病患者呼吸肌训练的最佳证据总结[J]. 中华护理杂志, 2022, 57(1):49-55. |
| Yang XN, Li XE, Wang S, et al. Summary of best evidence of respiratory muscle training in patients with chronic obstru-ctive pulmonary disease[J]. Chin J Nurs, 2022, 57(1):49-55. | |
| [37] | Saito A, Masuyama M, Ishiyama D, et al. Rapid recovery in a patient with severe COVID-19 after a low-load,high-frequen-cy rehabilitation program using an ergometer in the supine position[J]. J Nippon Med Sch, 2023, 90(5):414-418. |
| [38] | Capell EL, Tipping CJ, Hodgson CL. Barriers to implementing expert safety recommendations for early mobilisation in inten-sive care unit during mechanical ventilation:a prospective observational study[J]. Aust Crit Care, 2019, 32(3):185-190. |
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