Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing.
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.
Ezingeard
Eric
E
Intensive Care Unit, University Hospital Bellevue, 42055, St Etienne cedex 2, France. eezingeard@yahoo.fr
Diconne
Eric
E
Guyomarc'h
Stéphane
S
Venet
Christophe
C
Page
Dominique
D
Gery
Pierre
P
Vermesch
Régine
R
Bertrand
Monique
M
Pingat
Juliette
J
Tardy
Bernard
B
Bertrand
Jean-Claude
JC
Zeni
Fabrice
F
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