Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group.

نویسندگان

  • A Esteban
  • I Alía
  • F Gordo
  • R Fernández
  • J F Solsona
  • I Vallverdú
  • S Macías
  • J M Allegue
  • J Blanco
  • D Carriedo
  • M León
  • M A de la Cal
  • F Taboada
  • J Gonzalez de Velasco
  • E Palazón
  • F Carrizosa
  • R Tomás
  • J Suarez
  • R S Goldwasser
چکیده

A 2-h T-tube trial of spontaneous breathing was used in selecting patients ready for extubation and discontinuation of mechanical ventilation. However, some doubt remains as to whether it is the most appropriate method of performing a spontaneous breathing trial. We carried out a prospective, randomized, multicenter study involving patients who had received mechanical ventilation for more than 48 h and who were considered by their physicians to be ready for weaning according to clinical criteria and standard weaning parameters. Patients were randomly assigned to undergo a 2-h trial of spontaneous breathing in one of two ways: with a T-tube system or with pressure support ventilation of 7 cm H2O. If a patient had signs of poor tolerance at any time during the trial, mechanical ventilation was reinstituted. Patients without these features at the end of the trial were extubated. Of the 246 patients assigned to the T-tube group, 192 successfully completed the trial and were extubated; 36 of them required reintubation. Of the 238 patients in the group receiving pressure support ventilation, 205 were extubated and 38 of them required reintubation. The percentage of patients who remained extubated after 48 h was not different between the two groups (63% T-tube, 70% pressure support ventilation, p = 0.14). The percentage of patients falling the trial was significantly higher when the T-tube was used (22 versus 14%, p = 0.03). Clinical evolution during the trial was not different in patients reintubated and successfully extubated. ICU mortality among reintubated patients was significantly higher than in successfully extubated patients (27 versus 2.6%, p < 0.001). Spontaneous breathing trials with pressure support or T-tube are suitable methods for successful discontinuation of ventilator support in patients without problems to resume spontaneous breathing.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Automatic Tube Compensation versus Pressure Support Ventilation and Extubation Outcome in Children: A Randomized Controlled Study

Background. Automatic tube compensation (ATC) has been developed to overcome the imposed work of breathing due to artificial airways during spontaneous breathing trials (SBTs). Objectives. This study aimed to assess extubation outcome after an SBT (spontaneous breathing trial) with ATC compared with pressure support ventilation (PSV) and to determine the risk factors for extubation failure. Met...

متن کامل

The Role of Rapid Shallow Breathing Index in Predicting Successful Weaning of Pediatric Patients with Respiratory Failure

Background About 40 to 60% of all patients admitted to pediatric intensive care unitsundergo mechanical ventilation and 10 to 20% will fail to be extubated. We aimed to determine the role of the rapid shallow breathing index (RSBI) in predicting successful weaning of pediatric patients with respiratory failure.   Materials and Methods: This cross-sectional study, was performed on 72 mechanical...

متن کامل

Pressure support-ventilation versus spontaneous breathing with "T-Tube" for interrupting the ventilation after cardiac operations

OBJECTIVE To compare pressure-support ventilation with spontaneous breathing through a T-tube for interrupting invasive mechanical ventilation in patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS Adults of both genders were randomly allocated to 30 minutes of either pressure-support ventilation or spontaneous ventilation with "T-tube" before extubation. Manovacuometry, ...

متن کامل

Spontaneous Breathing Trial a Reliable Method for Weaning in Children

Introduction  Mechanical ventilation may be lifesaving intervention,It can be associated with complications,Thus,successful weaning is constitutive.One of the factors which is  important in successful weaning is  method of weaning. It is shown that  weaning is conducted successfully by using Spontaneous Breathing Trial (SBT) through T-piece and pressure support (PS) ventilation.But few studies ...

متن کامل

A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group.

BACKGROUND Weaning patients from mechanical ventilation is an important problem in intensive care units. Weaning is usually conducted in an empirical manner, and a standardized approach has not been developed. METHODS We carried out a prospective, randomized, multicenter study involving 546 patients who had received mechanical ventilation for a mean (+/- SD) of 7.5 +/- 6.1 days and who were c...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • American journal of respiratory and critical care medicine

دوره 156 2 Pt 1  شماره 

صفحات  -

تاریخ انتشار 1997