title: Comparison of Proportional Assist Ventilation Plus, T-Tube Ventilation, and Pressure Support Ventilation as Spontaneous Breathing Trials for Extubation: A Randomized Study.
abstract: BACKGROUND
  Failure to wean can prolong ICU stay, increase complications associated with mechanical ventilation, and increase morbidity and mortality. The spontaneous breathing trial (SBT) is one method used to assess weaning. The aim of this study was to assess proportional assist ventilation plus (PAV+) as an SBT by comparing its applicability, safety, and efficacy with T-tube and pressure support ventilation (PSV).
  
  
  METHODS
  A randomized study was performed involving 160 adult subjects who remained on mechanical ventilation for > 24 h. Subjects were randomly assigned to the PAV+, PSV, or T-tube group. When subjects were ready to perform the SBT, subjects in the PAV+ group were ventilated in PAV+ mode (receiving support of up to 40%), the pressure support was reduced to 7 cm H2O in the PSV group, and subjects in the T-tube group were connected to one T-piece with supplemental oxygen. Subjects were observed for signs of intolerance, whereupon the trial was interrupted. When the trial succeeded, the subjects were extubated and assessed until discharge.
  
  
  RESULTS
  The subjects were predominantly male (66.5%), and the leading cause of admission was traumatic brain injury. The groups were similar with respect to baseline characteristics, and no significant difference was observed among the groups regarding extubation success or failure. Analysis of the specificity and sensitivity revealed good sensitivity for all groups; however, the PAV+ group had higher specificity (66.6%) and higher sensitivity (97.6%), with prediction of ∼ 92.1% of the success and failure events.
  
  
  CONCLUSIONS
  No significant differences in the groups was observed regarding the rate of extubation failure, duration of mechanical ventilation, and ICU and hospital stay, indicating that PAV+ is an alternative for use as an SBT.
authors.affiliation: Intensive Care Unit sandy.fisio@hotmail.com.
authors.forename: Sandy Nogueira
authors.initials: SN
authors.lastname: Teixeira
authors.affiliation: Intensive Care Unit.
authors.forename: Erica Fernanda
authors.initials: EF
authors.lastname: Osaku
authors.affiliation: Intensive Care Unit.
authors.forename: Claudia Rejane Lima de Macedo
authors.initials: CR
authors.lastname: Costa
authors.affiliation: Intensive Care Unit.
authors.forename: Beatriz Fernandes
authors.initials: BF
authors.lastname: Toccolini
authors.affiliation: Intensive Care Unit.
authors.forename: Nicolle Lamberti
authors.initials: NL
authors.lastname: Costa
authors.affiliation: Intensive Care Unit.
authors.forename: Maria Fernanda
authors.initials: MF
authors.lastname: Cândia
authors.affiliation: Intensive Care Unit.
authors.forename: Marcela Aparecida
authors.initials: MA
authors.lastname: Leite
authors.affiliation: Intensive Care Unit Department of Medicine, Western Paraná State University Hospital, Cascavel, Paraná, Brazil.
authors.forename: Amaury Cezar
authors.initials: AC
authors.lastname: Jorge
authors.affiliation: Intensive Care Unit Department of Medicine, Western Paraná State University Hospital, Cascavel, Paraná, Brazil.
authors.forename: Péricles Almeida Delfino
authors.initials: PA
authors.lastname: Duarte
mesh_terms: D000328:Adult; D060666:Airway Extubation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D059725:Interactive Ventilatory Support; D007442:Intubation, Intratracheal; D008297:Male; D011446:Prospective Studies; D012119:Respiration; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D015300:Ventilator Weaning / Q000379:methods*
keywords: airway extubation; artificial; intensive care units; mortality; protocols; respiration; respiratory insufficiency; ventilator weaning