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

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.
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Contributor : Patrick Mismetti Connect in order to contact the contributor
Submitted on : Wednesday, December 9, 2009 - 12:03:41 PM
Last modification on : Tuesday, April 19, 2022 - 10:11:19 AM

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Eric Ezingeard, Eric Diconne, Stéphane Guyomarc'H, Christophe Venet, Dominique Page, et al.. Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing.. Intensive Care Medicine, 2006, 32 (1), pp.165-9. ⟨10.1007/s00134-005-2852-5⟩. ⟨ujm-00440079⟩



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