title: 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.
  
  
  METHODS
  This was a prospective, non-randomized study in two French intensive care units.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Intensive Care Unit, University Hospital Bellevue, 42055, St Etienne cedex 2, France. eezingeard@yahoo.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Ezingeard
authors.forename: Eric
authors.initials: E
authors.lastname: Diconne
authors.forename: Stéphane
authors.initials: S
authors.lastname: Guyomarc'h
authors.forename: Christophe
authors.initials: C
authors.lastname: Venet
authors.forename: Dominique
authors.initials: D
authors.lastname: Page
authors.forename: Pierre
authors.initials: P
authors.lastname: Gery
authors.forename: Régine
authors.initials: R
authors.lastname: Vermesch
authors.forename: Monique
authors.initials: M
authors.lastname: Bertrand
authors.forename: Juliette
authors.initials: J
authors.lastname: Pingat
authors.forename: Bernard
authors.initials: B
authors.lastname: Tardy
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Bertrand
authors.forename: Fabrice
authors.initials: F
authors.lastname: Zeni
mesh_terms: D006801:Humans; D007384:Intermittent Positive-Pressure Breathing; D007442:Intubation, Intratracheal; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D015300:Ventilator Weaning / Q000379:methods*; D014939:Work of Breathing