Intensive Care Medicine

, Volume 32, Issue 1, pp 165–169 | Cite as

Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing

  • Eric Ezingeard
  • Eric Diconne
  • Stéphane Guyomarc’h
  • Christophe Venet
  • Dominique Page
  • Pierre Gery
  • Régine Vermesch
  • Monique Bertrand
  • Juliette Pingat
  • Bernard Tardy
  • Jean-Claude Bertrand
  • Fabrice Zeni
Brief Report

Abstract

Objective

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.

Interventions

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).

Conclusions

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.

Keywords

Weaning from mechanical ventilation Spontaneous breathing trial with T-tube Pressure support 

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Eric Ezingeard
    • 1
    • 2
  • Eric Diconne
    • 1
  • Stéphane Guyomarc’h
    • 1
  • Christophe Venet
    • 1
  • Dominique Page
    • 1
  • Pierre Gery
    • 1
  • Régine Vermesch
    • 1
  • Monique Bertrand
    • 1
  • Juliette Pingat
    • 1
  • Bernard Tardy
    • 1
  • Jean-Claude Bertrand
    • 1
  • Fabrice Zeni
    • 1
  1. 1.Intensive Care UnitUniversity Hospital BellevueSt Etienne cedex 2France
  2. 2.Intensive Care UnitClinique MutualisteSt EtienneFrance

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