Characteristics and risk factors of patients with chronic diseases at high risk for ventilator dependence

doi:10.3877/cma.j.issn.2096-1537.2026.01.006

Abstract

Abstract:

Ventilator dependence is a common clinical challenge in the ICU. Mechanically ventilated patients with comorbidities are more likely to develop ventilator dependence, which is closely associated with poor prognosis and a significant healthcare burden. This review focuses on populations with major chronic diseases, affecting different systems, including the respiratory, cardiovascular, neuromuscular, and endocrine systems, as well as chronic kidney disease. It summarizes the current epidemiology, population characteristics, and high-risk factors for ventilator dependence in these populations. The goal is to provide a basis for more refined subgroup analysis, exploration of multi-dimensional indicators, and ultimately the achievement of early and precise identification and intervention for specific chronic disease populations.

Key words: Ventilator dependence, Prolonged mechanical ventilation, Chronic diseases, Risk factors, Intensive care

Xu Huang. Characteristics and risk factors of patients with chronic diseases at high risk for ventilator dependence[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2026, 12(01): 31-36.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2026.01.006

https://icu.cma-cmc.com.cn/EN/Y2026/V12/I01/31

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呼吸机依赖高危因素	具体高危因素	高危因素说明
基础慢病	呼吸系统慢病：COPD、限制性胸廓疾病、OSAHS 心血管系统慢病：高血压、心血管疾病、慢性心力衰竭神经肌肉系统慢病：脑卒中、神经肌肉疾病、脊髓损伤、精神心理障碍内分泌慢病：糖尿病慢病综合评分	GOLD分级高未控制的糖尿病查尔森合并症指数高
年龄	高龄
性别	男性
BMI	≥30 kg/m²
营养	营养不良；血清白蛋白、前白蛋白低
衰弱	CFS＞4分
疾病严重程度	SOFA评分	高SOFA评分
	APACHE Ⅱ/Ⅲ评分	APACHE Ⅲ评分＞36分
	GCS评分	低GCS
住院	入院原因	呼吸系统疾病入院
机械通气	上机原因	气道痉挛、肺炎、AECOPD、神经肌肉疾病恶化

呼吸机依赖高危因素	具体高危因素	高危因素说明
基础慢病	呼吸系统慢病：COPD、限制性胸廓疾病、OSAHS 心血管系统慢病：高血压、心血管疾病、慢性心力衰竭神经肌肉系统慢病：脑卒中、神经肌肉疾病、脊髓损伤、精神心理障碍内分泌慢病：糖尿病慢病综合评分	GOLD分级高未控制的糖尿病查尔森合并症指数高
年龄	高龄
性别	男性
BMI	≥30 kg/m²
营养	营养不良；血清白蛋白、前白蛋白低
衰弱	CFS＞4分
疾病严重程度	SOFA评分	高SOFA评分
	APACHE Ⅱ/Ⅲ评分	APACHE Ⅲ评分＞36分
	GCS评分	低GCS
住院	入院原因	呼吸系统疾病入院
机械通气	上机原因	气道痉挛、肺炎、AECOPD、神经肌肉疾病恶化

呼吸机依赖高危因素	具体高危因素	高危因素说明
机械通气因素	MV时间	＞30 d
	MV模式	不能耐受PSV 24 h以上
	撤机准备度测试当天RSBI	RSBI＞100
	气管切开	MV 14 d后气管切开
	SBT	延迟SBT；第1次SBT时PaCO₂升高、氧合指数下降、心率增快；SBT失败；SBT方式、时间
	机械通气期间呼吸生理	经动态肺/胸廓顺应性和理想体质量标化的机械能升高；MV期间动态呼吸系统顺应性下降；Pimax下降；较低的咳嗽峰流速
	神经心理因素	镇静过深，RASS -4~-5分镇静药物的长期应用 ICU谵妄焦虑抑郁睡眠剥夺
	机械通气期间膈肌功能	膈肌超声：膈肌厚度减低 SBT 1 h膈肌活动度、DE、DTF
并发症	院内感染	VAP；MDR感染；反复误吸
	AKI
	休克

呼吸机依赖高危因素	具体高危因素	高危因素说明
机械通气因素	MV时间	＞30 d
	MV模式	不能耐受PSV 24 h以上
	撤机准备度测试当天RSBI	RSBI＞100
	气管切开	MV 14 d后气管切开
	SBT	延迟SBT；第1次SBT时PaCO₂升高、氧合指数下降、心率增快；SBT失败；SBT方式、时间
	机械通气期间呼吸生理	经动态肺/胸廓顺应性和理想体质量标化的机械能升高；MV期间动态呼吸系统顺应性下降；Pimax下降；较低的咳嗽峰流速
	神经心理因素	镇静过深，RASS -4~-5分镇静药物的长期应用 ICU谵妄焦虑抑郁睡眠剥夺
	机械通气期间膈肌功能	膈肌超声：膈肌厚度减低 SBT 1 h膈肌活动度、DE、DTF
并发症	院内感染	VAP；MDR感染；反复误吸
	AKI
	休克

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