Automatic Tube Compensation in the Weaning Process

  • J. Cohen
  • M. Shapiro
  • P. Singer
Conference paper


Unnecessarily prolonging or prematurely discontinuing mechanical ventilation may result in significant morbidity and even mortality. In order to optimize the timing of ventilation discontinuation, evidence-based guidelines suggest that patients undergo a daily screen (for measures of oxygenation, cough and secretions, adequate mental status, and hemodynamic stability) to assess weaning readiness [1]. For patients meeting the criteria, a spontaneous breathing trial is then performed in order to assess their ability to breathe unaided. The way the trial is tolerated, determined by both objective (respiratory and hemodynamic parameters) and subjective (evidence of increased work of breathing and distress) criteria, determines whether extubation is performed.


Chronic Obstructive Pulmonary Disease Continuous Positive Airway Pressure Endotracheal Tube Pressure Support Ventilation Spontaneous Breathing Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    MacIntyre NR, Cook DJ, Ely EW Jr, et al (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Crit Care Med. Chest 120 (Suppl 6):375S–395SCrossRefPubMedGoogle Scholar
  2. 2.
    Seymour CW, Halpern S, Christie JD, Gallop R, Fuchs BD (2008) Minute ventilation recovery time measured using a new simplified methodology predicts extubation outcome. J Intensive Care 23: 52–60CrossRefGoogle Scholar
  3. 3.
    Chien J, Lin M, Huang YT, Chien Y, Yu C, Yang P (2008) Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial. Crit Care Med 36: 1421–26CrossRefPubMedGoogle Scholar
  4. 4.
    Robertson E, Sona C, Schallom L, et al (2008) Improved extubation rates and earlier liberation from mechanical ventilation with implementation of a daily spontaneous-breathing trial protocol. J Am Coll Surg 206: 489–95CrossRefPubMedGoogle Scholar
  5. 5.
    Frutos-Vivar F, Esteban A (2003) When to wean from a ventilator: an evidence-based strategy. Clev Clin J Med 70: 389–400CrossRefGoogle Scholar
  6. 6.
    Koksal GM, Sayilgan C, Sen O, Oz H (2004) The effects of different weaning modes on the endocrine stress response. Crit Care 8: R31–34CrossRefPubMedGoogle Scholar
  7. 7.
    Esteban A, Alia I, Gordo F, et al (1997) Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med 156: 459–465PubMedGoogle Scholar
  8. 8.
    Petrof BJ, Legare M, Goldberg P, Milic-Emili J, Gottfried SB (1990) Continuous positive airway pressure reduces the work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 141: 281–289PubMedGoogle Scholar
  9. 9.
    Brochard L, Rua F, Lorino H, Lemaire F, Harf A (1991) Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anaesthesiology 75: 739–745CrossRefGoogle Scholar
  10. 10.
    Fabry B, Guttman J, Eberhard L, Wolff G (1994) Automatic tube compensation of endotracheal tube resistance in spontaneously breathing patients. Tech Health Care 1: 281–291Google Scholar
  11. 10.
    Haberthur C, Elsasser S, Eberhard L, Stocker R, Guttmann J (2000) Total versus tube-related additional work of breathing in ventilator-dependent patients. Acta Anaesthesiol Scand 44: 749–757CrossRefPubMedGoogle Scholar
  12. 11.
    Guttmann, J, Eberhard, L, Fabry, B, et al (1993) Continuous calculation of intratracheal pressure in tracheally intubated patients. Anaesthesiology 79: 503–513CrossRefGoogle Scholar
  13. 12.
    Fabry, B, Haberthur, C, Zappe, D, et al (1997) Breathing pattern and additional work of breathing in spontaneously breathing patients with different ventilatory demands during inspiratory pressure support and automatic tube compensation. Intensive Care Med 23: 545–552CrossRefPubMedGoogle Scholar
  14. 13.
    Guttmann J, Bernhard H, Mols G, et al (1997) Respiratory comfort of automatic tube compensation and inspiratory pressure support in conscious humans. Intensive Care Med 23: 1119–1124CrossRefPubMedGoogle Scholar
  15. 14.
    Haberthur C, Fabry, Zappe D, et al (1998) Effects of mechanical unloading and mechanical loading on respiratory loop gain and periodic breathing in man. Respir Physiol 112: 23–36CrossRefPubMedGoogle Scholar
  16. 15.
    Stocker R, Fabry B, Haberthur C (1997) New modes of ventilatory support in spontaneously breathing intubated patients. In: Vincent JL (ed) Yearbook of Intensive Care and Emergency Medicine. Springer, Heidelberg, 514–533Google Scholar
  17. 16.
    Elsasser S, Guttmann J, Stocker R, Mois G, Priebe HJ, Haberthur C (2003) Accuracy of automatic tube compensation in new-generation mechanical ventilators. Crit Care Med 31: 2619–2626CrossRefPubMedGoogle Scholar
  18. 17.
    Haberthur C, Mols G, Elsasser S, Bingisser R, Stocker R, Guttmann J (2002) Extubation after breathing trials with automatic tube compensation, T-tube or pressure support ventilation. Acta Anaesthesiol Scand 46: 973–979CrossRefPubMedGoogle Scholar
  19. 18.
    Ferreyra G, Weber-Cartens S, Aquadrone V, et al (2007) Comparison of automatic tube compensation (ATC) with pressure support ventilation (PSV) during spontaneous breathing trials. Intensive Care Med 33: s57 (abst)Google Scholar
  20. 19.
    Cohen J, Shapiro M, Grozovski E, Lev S, Fisher H, Singer P (2006) Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure. Crit Care Med 34: 682–686CrossRefPubMedGoogle Scholar
  21. 20.
    Eskandar N, Apostolakos MJ (2007) Weaning from mechanical ventilation. Crit Care Clin 23: 263–274CrossRefPubMedGoogle Scholar
  22. 21.
    Siner JM, Manthous CA (2007) Liberation from mechanical ventilation: what monitoring matters? Crit Care Clin 23: 613–638CrossRefPubMedGoogle Scholar
  23. 22.
    Frutos-Vivar F, Ferguson ND, Esteban A, et al (2006) Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 130: 1664–1671CrossRefPubMedGoogle Scholar
  24. 23.
    Ely W, Baker AM, Dunagan DP, et al (1996) Effect on the duration of mechanical ventilation of identifying patients capable of spontaneous ventilation. N Eng J Med 335: 1864–1869CrossRefGoogle Scholar
  25. 24.
    Lee KH, Hui KP, Chan TB, et al (1994) Rapid shallow breathing (frequency to tidal volume ratio) did not predict extubation outcome. Chest 105: 540–543CrossRefPubMedGoogle Scholar
  26. 25.
    Chatila, W, Jacob, B, Guanglione, D, et al (1996) The unassisted respiratory rate: tidal volume ratio accurately predicts weaning outcome. Am J Med 101: 61–67CrossRefPubMedGoogle Scholar
  27. 26.
    Cohen JD, Shapiro M, Grozovski E, Singer P (2002) Automatic tube compensation-assisted respiratory rate to tidal volume ratio improves the prediction of weaning outcome. Chest 122: 980–984CrossRefPubMedGoogle Scholar
  28. 27.
    Unoki T, Serita A, Grap MJ (2008) Automatic tube compensation during weaning from mechanical ventilation. Evidence and clinical implications. Crit Care Nurse 28: 34–42PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • J. Cohen
    • 1
  • M. Shapiro
    • 1
  • P. Singer
    • 1
  1. 1.General Intensive Care UnitRabin Medical CenterPetah TikvaIsrael

Personalised recommendations