Supplementary Material for: A multidimensional approach to the management of patients in prolonged weaning from mechanical ventilation – the concept of treatable traits – a narrative review

Background
Established structured weaning approaches, which are effective for patients in simple and difficult weaning, are often not appropriate for patients undergoing prolonged weaning. Addressing the complexity of weaning failure requires personalized precision medicine. The therapeutic concept of Treatable Traits (TTs) has been proposed as a new paradigm for the management of chronic respiratory diseases. It is based on a multidimensional assessment of specific characteristics, which can be addressed by specific interventions that go beyond traditional diagnostic criteria. The concept is increasingly adopted for other complex diseases.
Summary
This is a narrative review and an expert opinion on the development of a concept of TTs for patients undergoing prolonged weaning. The proposed TTs are based on a systematic review of risk factors for prolonged weaning, an analysis of claims data to assess risk factors within 96 hours of IMV onset and data from the WEAN-SAFE study. A multidisciplinary team identified clinically important TTs and determined appropriate interventions. The following TTs have been identified: Airway disorders and complications associated with tracheostomy or intubation, such as airway obstruction, strictures or tracheomalacia, infectious aspects, anxiety, depression, delirium, post-traumatic stress disorder, anemia, pulmonary and cardio-renal disease. The multidimensional holistic approach also includes tailored sedation and pain management, nutritional therapy, early mobilization and physiotherapy.
Key message
We propose a framework of relevant considerations for a multidimensional approach to the management of patients undergoing prolonged weaning that supports the regain of respiratory capacity, reduces the respiratory load and thus could resolve the respiratory workload imbalance.

【背景】
现有结构化撤机方案虽可有效应对简单及复杂撤机场景下的患者，但往往不适用于需长期撤机的人群。针对撤机失败的复杂情形，需采用个性化精准医学策略。可治疗特征（Treatable Traits，TTs）这一治疗理念已被提出，作为慢性呼吸系统疾病管理的全新范式。该理念基于对患者特定特征的多维度评估，可通过超越传统诊断标准的针对性干预措施对相关特征进行干预。目前这一理念正逐步被应用于其他复杂疾病的管理中。

【综述概要】
本研究为针对长期撤机患者可治疗特征理念发展的叙述性综述及专家观点。所提出的可治疗特征基于对长期撤机危险因素的系统综述、对有创机械通气（Invasive Mechanical Ventilation，IMV）启动后96小时内行政索赔数据的风险因素分析，以及WEAN-SAFE研究的数据。多学科团队明确了具有临床意义的可治疗特征，并确定了相应的干预措施。已识别的可治疗特征包括：与气管切开术或气管插管相关的气道疾病及并发症（如气道梗阻、气道狭窄或气管软化症）、感染相关因素、焦虑、抑郁、谵妄、创伤后应激障碍、贫血、肺部及心肾疾病。这种多维度整体干预策略还涵盖了个体化镇静与疼痛管理、营养治疗、早期活动及物理治疗。

【核心观点】
我们提出了一套适用于长期撤机患者管理的多维度策略考量框架，该框架可助力患者呼吸功能恢复、降低呼吸负荷，从而改善呼吸做功失衡的状态。