Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing
Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial.
Design and setting
This was a prospective, non-randomized study in two French intensive care units.
Patients and participants
One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87 were extubated. Thirty-one underwent a further trial with PS, after which 21 were extubated.
All patients under MV >24 h meeting the criteria for a weaning test underwent a 30-min T-tube trial. If this was successful, they were immediately extubated. Otherwise, a 30-min trial with +7 cm H2O PS was initiated with an individualized pressurization slope and trigger adjustment. If all weaning criteria were met, the patients were extubated; otherwise, MV was reinstated.
Measurements and Results
The extubation failure rate at 48 h did not differ significantly between the groups: 11/87 (13%) versus 4/21 (19%), P=0.39. The groups were comparable with regard to endotracheal tube diameter, MV duration, the use of non-invasive ventilation (NIV) after extubation, initial severity score, age and underlying pathology, except for COPD. A significantly higher percentage of patients with COPD was extubated after the trial with PS (8/21–38%) than after a single T-tube trial (11/87–13%) (P=0.003).
Of the patients, 21/118 (18%) could be extubated after a trial with PS, despite having failed a T-tube trial. The reintubation rate was not increased. This protocol may particularly benefit patients who are most difficult to wean, notably those with COPD.
KeywordsWeaning from mechanical ventilation Spontaneous breathing trial with T-tube Pressure support
- 1.Esteban A, Alia I, Gordo F, Fernandez R, F. Solsona J, Vallverdu I, Macias S, M. Allegue J, Blanco J, Carriedo D, Leon M, A. de la Cal M, Taboada F, Gonzales de Velasco J, Palazon E, Carrizosa F, Tomas R, Suarez J, Goldwasser R, for the Spanish Lung Failure Collaborative Group (1997) Extubation utcome after spontaneous breathing trials with T-Tube or pressure support ventilation. Am J Respir Crit Care Med 156:459–465PubMedGoogle Scholar
- 2.Farias JA, Retta A, Alia I, Olazarri F, Esteban A, Golubicki A, Allende D, Marliartchuk O, Peltzer C, Ratto ME, Zalazar R, Garea M, Moreno E (2001) A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients. Int Care Med 27:1649–1654CrossRefGoogle Scholar
- 10.Richard J, Clabault K (2001) Modalities of spontaneous breathing trials. Réanimation 10:738–743Google Scholar
- 19.Bonmarchand G, Chevron V, Chopin C, Jusserand D, Girault C, Moritz F, Leroy J, Pasquis P (1996) Increased initial flow rate reduces inspiratory work of breathing during pressure support ventilation in patients with exacerbation of chronic obstructive pulmonary disease. Int Care Med 22:1147–1154Google Scholar