Journal of Intensive Care Medicine

Home | User not signed in

Official Journal of the ESICM and the ESPNIC

Log in | Register

Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing

Eric Ezingeard, Eric Diconne, Stéphane Guyomarc’h, Christophe Venet, Dominique Page, Pierre Gery, Régine Vermesch, Monique Bertrand, Juliette Pingat, Bernard Tardy, Jean-Claude Bertrand, Fabrice Zeni
Brief Report
Volume 32, Issue 1 / January , 2006

Pages 165 - 169

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.

Design and setting

This was a prospective, non-randomized study in two French intensive care units.

Patients and participants

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.

Interventions

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.

Measurements and 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.

Keywords

References

  1. Esteban A, Alia I, Gordo F, Fernandez R, F. Solsona J, Vallverdu I, Macias S, M. Allegue J, Blanco J, Carriedo D, Leon M, A. de la Cal M, Taboada F, Gonzales de Velasco J, Palazon E, Carrizosa F, Tomas R, Suarez J, Goldwasser R, for the Spanish Lung Failure Collaborative Group (1997) Extubation utcome after spontaneous breathing trials with T-Tube or pressure support ventilation. Am J Respir Crit Care Med 156:459–465
    • View reference on PubMed
  2. Farias JA, Retta A, Alia I, Olazarri F, Esteban A, Golubicki A, Allende D, Marliartchuk O, Peltzer C, Ratto ME, Zalazar R, Garea M, Moreno E (2001) A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients. Int Care Med 27:1649–1654
    • View reference on publisher's website
  3. Richard C, Beydon L, Cantagrel S, Cuvelier A, Fauroux B, Garo B, Holzapfel L, Lesieur O, Levraut J, Maury E, Polet C, Roche N, Roeseler J (2001) Weaning from mechanical ventilation. Consensus recommendations. Reanimation 10:697–698
    • View reference on publisher's website
  4. Fiastro JF, Habib MP, Quan SF (1988) Pressure support compensation for inspiratory work due to endotracheal tubes and demand continuous positive airway pressure. Chest 93:499–505
    • View reference on PubMed
  5. Straus C, Louis B, Isabey D, Lemaire F, Harf A, Brochard L (1998) Contribution of the endotracheal tube and the upper airway to breathing workload. Am J Respir Crit Care Med 157:23–30
    • View reference on PubMed
  6. Brochard L, Rua F, Lorino H, Lemaire F, Harf A (1991) Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anesthesiology 75:739–745
    • View reference on PubMed
  7. Nathan SD, Ishaaya AM, Koerner SK, Belman MJ (1993) Prediction of minimal pressure support during weanig from mechanical ventilation. Chest 103:1215–1219
    • View reference on PubMed
  8. Kuhlen R, Max M, Dembinski R, Terbeck S, Jurgens E, Rossaint R (2003) Breathing pattern and workload during automatic tube compensation, pressure support and T-piece trials in weaning patients. Eur J Anaesthesiol 20:10–16
    • View reference on publisher's website
    • View reference on PubMed
  9. Conti G, De Blasi RA, Lappa A, Ferretti A, Antonelli M, Bufi M, Gasparetto A (1994) Evaluation of respiratory system resistance in mechanically ventilated patients: the role of the endotracheal tube. Int Care Med 20:421–424
    • View reference on publisher's website
  10. Richard J, Clabault K (2001) Modalities of spontaneous breathing trials. Réanimation 10:738–743
  11. Pelosi P, Solca M, Ravagnan I, Tubiolo D, Ferrario L, Gattinoni L (1996) Effects of heat and moisture exchangers on minute ventilation, ventilatory drive, and work of breathing during pressure-support ventilation in acute respiratory failure. Crit Care Med 24:1184–1188
    • View reference on publisher's website
    • View reference on PubMed
  12. Girault C, Breton L, Richard JC, Tamion F, Vandelet P, Aboab J, Leroy J, Bonmarchand G (2003) Mechanical effects of airway humidification devices in difficult to wean patients. Crit Care Med 31:1306–1311
    • View reference on publisher's website
    • View reference on PubMed
  13. Shah C, Kollef MH (2004) Endotracheal tube intraluminal volume loss among mechanically ventilated patients. Crit Care Med 32:120–125
    • View reference on publisher's website
    • View reference on PubMed
  14. Ishaaya AM, Nathan SD, Belman MJ (1995) Work of breathing after extubation. Chest 107:204–209
    • View reference on PubMed
  15. Swinamer DL, Fedoruk LM, Jones RL, Chin WD, Phang PT, Hamilton SM, King EG (1989) Energy expenditure associated with CPAP and T-piece spontaneous ventilatory trials. Changes following prolonged mechanical ventilation. Chest 96:867–872
    • View reference on PubMed
  16. Bonmarchand G, Chevron V, Menard JF, Girault C, Moritz-Berthelot F, Pasquis P, Leroy J (1999) Effects of pressure ramp slope values on the work of breathing during pressure support ventilation in restrictive patients. Crit Care Med 27:715–722
    • View reference on publisher's website
    • View reference on PubMed
  17. Aslanian P, El Atrous S, Isabey D, Valente E, Corsi D, Harf A, Lemaire F, Brochard L (1998) Effects of flow triggering on breathing effort during partial ventilatory support. Am J Respir Crit Care Med 157:135–143
    • View reference on PubMed
  18. Mancebo J, Amaro P, Mollo JL, Lorino H, Lemaire F, Brochard L (1995) Comparison of the effects of pressure support ventilation delivered by three ventilators during weaning from mechanical ventilation. Int Care Med 21:913–919
    • View reference on publisher's website
  19. Bonmarchand G, Chevron V, Chopin C, Jusserand D, Girault C, Moritz F, Leroy J, Pasquis P (1996) Increased initial flow rate reduces inspiratory work of breathing during pressure support ventilation in patients with exacerbation of chronic obstructive pulmonary disease. Int Care Med 22:1147–1154

Sign In

Top 5 Articles Letters to the Editor

Reader Poll

Do you think that the new website is an improvement for the journal?

View previous poll results