title: Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group.
abstract: 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.
authors.affiliation: Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Esteban
authors.forename: I
authors.initials: I
authors.lastname: Alía
authors.forename: F
authors.initials: F
authors.lastname: Gordo
authors.forename: R
authors.initials: R
authors.lastname: Fernández
authors.forename: J F
authors.initials: JF
authors.lastname: Solsona
authors.forename: I
authors.initials: I
authors.lastname: Vallverdú
authors.forename: S
authors.initials: S
authors.lastname: Macías
authors.forename: J M
authors.initials: JM
authors.lastname: Allegue
authors.forename: J
authors.initials: J
authors.lastname: Blanco
authors.forename: D
authors.initials: D
authors.lastname: Carriedo
authors.forename: M
authors.initials: M
authors.lastname: León
authors.forename: M A
authors.initials: MA
authors.lastname: de la Cal
authors.forename: F
authors.initials: F
authors.lastname: Taboada
authors.forename: J
authors.initials: J
authors.lastname: Gonzalez de Velasco
authors.forename: E
authors.initials: E
authors.lastname: Palazón
authors.forename: F
authors.initials: F
authors.lastname: Carrizosa
authors.forename: R
authors.initials: R
authors.lastname: Tomás
authors.forename: J
authors.initials: J
authors.lastname: Suarez
authors.forename: R S
authors.initials: RS
authors.lastname: Goldwasser
mesh_terms: D000368:Aged; D001118:Argentina; D001938:Brazil; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012119:Respiration; D012131:Respiratory Insufficiency / Q000628:therapy; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014687:Venezuela; D015300:Ventilator Weaning / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data