Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure.
OBJECTIVE
We hypothesized that the additional use of automatic tube compensation (ATC) during a spontaneous breathing trial with continuous positive airway pressure (CPAP), by minimizing respiratory work, would result in more patients undergoing successful extubation.


METHODS
Prospective, randomized, controlled study.


METHODS
A ten-bed, general intensive care department at a tertiary-care hospital.


METHODS
Adult patients (n=99) who had undergone mechanical ventilation for >24 hrs and met defined criteria for a weaning trial.


METHODS
Patients were randomized to undergo a 1-hr spontaneous breathing trial with either ATC with CPAP (ATC group, n=51) or CPAP alone (CPAP group, n=48). ATC was provided by commercially available mechanical ventilators. Patients tolerating the spontaneous breathing trial underwent immediate extubation. The primary outcome measure was successful extubation, defined as the ability to maintain spontaneous breathing for 48 hrs after discontinuation of mechanical ventilation and extubation.


RESULTS
There were no significant differences in demographic, respiratory, or hemodynamic characteristics between the two groups at the start of the spontaneous breathing trial. There was a trend for more patients in the ATC group to tolerate the breathing trial and undergo extubation (96% vs. 85%; p=.08). The rate of reintubation was 14% in the ATC group and 24% in the CPAP group (p=.28). Significantly more patients in the ATC group thus met the criteria for successful extubation (82% vs. 65%; p=0.04).


CONCLUSIONS
This is the largest single-center study to date assessing the use of commercially available ATC and suggests that this might be a useful mode for performing a spontaneous breathing trial preceding extubation in a general intensive care population.
Cohen
Jonathan D
JD
Department of General Intensive Care, Rabin Medical Center, Campus Beilinson, Petah Tikva, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. jonatanc@clalit.org.il
Shapiro
Maury
M
Grozovski
Elad
E
Lev
Shaul
S
Fisher
Heran
H
Singer
Pierre
P
D000704:Analysis of Variance; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012129:Respiratory Function Tests; D015300:Ventilator Weaning / Q000379:methods*; D014939:Work of Breathing