Pressure support-ventilation versus spontaneous breathing with “T-Tube” for interrupting the ventilation after cardiac operations

Lourenço, Isabela Scali; Franco, Aline Marques; Bassetto, Solange; Rodrigues, Alfredo José

doi:10.5935/1678-9741.20130075

Cited by 13 publications

(32 citation statements)

References 25 publications

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“…Eight of the 12 included studies were single-center studies. [30][31][32][33][34][35][36][37] One study was pub-lished only in abstract form, 37 and full details of the study were not available to the authors of this review. Table 1 summarizes the components of the risk of bias assessment.…”

Section: Study Descriptionmentioning

confidence: 99%

“…Six studies included simple-to-wean subjects, according to previously published definitions. 2,[30][31][32]35,36,39 Three studies assessed difficult-to-wean subjects, 33,38,40 and 2 studies included prolonged-weaning and tracheostomized subjects. 34,41 Two additional studies evaluated postoperative subjects.…”

Section: Study Protocolsmentioning

confidence: 99%

“…34,41 Two additional studies evaluated postoperative subjects. 35,37 In the studies that predefined the SBT duration, a 120min trial was most commonly employed (7 studies). Three authors reported progressively increasing duration of SBTs based on subjects' tolerance.…”

Section: Study Protocolsmentioning

confidence: 99%

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Spontaneous Breathing Trials With T-Piece or Pressure Support Ventilation

et al. 2016

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Spontaneous breathing trials (SBTs) are among the most commonly employed techniques to facilitate weaning from mechanical ventilation. The preferred SBT technique, however, is still unclear. To clarify the preferable SBT (T-piece or pressure support ventilation [PSV]), we conducted this systematic review. We then searched the MEDLINE, EMBASE, SciELO, Google Scholar, CINAHL, ClinicalTrials.gov, and Cochrane CENTRAL databases through June 2015, without language restrictions. We included randomized controlled trials involving adult subjects being weaned from mechanical ventilation comparing T-piece with PSV and reporting (1) weaning failure, (2) re-intubation rate, (3) ICU mortality, or (4) weaning duration. Anticipating clinical heterogeneity among the included studies, we compared prespecified subgroups: (1) simple, difficult, or prolonged weaning and (2) subjects with COPD. We summarized the quality of evidence for intervention effects using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. We identified 3,674 potentially relevant studies and reviewed 23 papers in full. Twelve studies (2,161 subjects) met our inclusion criteria. Overall, the evidence was of very low to low quality. SBT technique did not influence weaning success (risk ratio 1.23 [0.94-1.61]), ICU mortality (risk ratio 1.11 [0.80-1.54]), or re-intubation rate (risk ratio 1.21 [0.90-1.63]). Prespecified subgroup analysis suggested that PSV might be superior to T-piece with regard to weaning success for simple-to-wean subjects (risk ratio 1.44 [1.11-1.86]). For the prolonged-weaning subgroup, however, T-piece was associated with a shorter weaning duration (weighted mean difference -3.08 [-5.24 to -0.92] d). In conclusion, low-quality evidence is available concerning this topic. PSV may be associated with lower weaning failure rates in the simple-to-wean subgroup. In contrast, in prolonged-weaning subjects, T-piece may be related to a shorter weaning duration, although this is at high risk of bias. Further study of the difficult-to-wean and COPD subgroups is required.

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Section: Study Descriptionmentioning

confidence: 99%

Section: Study Protocolsmentioning

confidence: 99%

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Spontaneous Breathing Trials With T-Piece or Pressure Support Ventilation

et al. 2016

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“…Lourenço et al. found no difference in a radiographical atelectasis index assessed from plain chest radiographs in cardiac surgery patients when comparing T‐piece to pressure supported breathing during weaning from postoperative mechanical ventilation . On the other hand, spontaneous breathing efforts with accentuated negative swings in Pes have been associated with levels of P L that may be as high as during controlled ventilation and potentially deleterious to the lung .…”

Section: Discussionmentioning

confidence: 99%

Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model

Gudmundsson

Perchiazzi

Pellegrini

et al. 2017

Acta Anaesthesiol Scand

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Background: In mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (P L ) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between P L and atelectasis were known, monitoring of P L might help to avoid formation of atelectasis and cyclic collapse during weaning. The main purpose of this study was to determine the relation between P L and atelectasis in an experimental model representing weaning from mechanical ventilation. Methods: Dynamic transverse computed tomography scans were acquired in ten anaesthetized, surfactant-depleted pigs with preserved spontaneous breathing, as ventilator support was lowered by sequentially reducing inspiratory pressure and positive end expiratory pressure in steps. The volumes of gas and atelectasis in the lungs were correlated with P L obtained using oesophageal pressure recordings. Work of breathing (WOB) was assessed from Campbell diagrams. Results: Gradual decrease in P L in both end-expiration and endinspiration caused a proportional increase in atelectasis and decrease in the gas content (linear mixed model with an autoregressive correlation matrix; P < 0.001) as the WOB increased. However, cyclic alveolar collapse during tidal ventilation did not increase significantly. Conclusion: We found a proportional correlation between atelectasis and P L during the 'weaning process' in experimental mild lung injury. If confirmed in the clinical setting, a gradual tapering of ventilator support can be recommended for weaning without risk of sudden formation of atelectasis.

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“…Invasive mechanical ventilation (IMV) is essential during the first few hours after CABG to allow recovery from anesthesia and reestablish homeostasis [ 5 ] . Typical restoration of hemodynamic stability occurs 5–6 h after surgery in uncomplicated CABG.…”

Section: Introductionmentioning

confidence: 99%

Relationship between pre-extubation positive end-expiratory pressure and oxygenation after coronary artery bypass grafting

Lima¹,

Borges²,

Costa³

et al. 2015

Revista Brasileira De Cirurgia Cardiovascular

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IntroductionAfter removal of endotracheal tube and artificial ventilation, ventilatory support should be continued, offering oxygen supply to ensure an arterial oxygen saturation close to physiological.ObjectiveThe aim of this study was to investigate the effects of positive-end expiratory pressure before extubation on the oxygenation indices of patients undergoing coronary artery bypass grafting.MethodsA randomized clinical trial with seventy-eight patients undergoing coronary artery bypass grafting divided into three groups and ventilated with different positive-end expiratory pressure levels prior to extubation: Group A, 5 cmH2O (n=32); Group B, 8 cmH2O (n=26); and Group C, 10 cmH2O (n=20). Oxygenation index data were obtained from arterial blood gas samples collected at 1, 3, and 6 h after extubation. Patients with chronic pulmonary disease and those who underwent off-pump, emergency, or combined surgeries were excluded. For statistical analysis, we used Shapiro-Wilk, G, Kruskal-Wallis, and analysis of variance tests and set the level of significance at P<0.05.ResultsGroups were homogenous with regard to demographic, clinical, and surgical variables. There were no statistically significant differences between groups in the first 6 h after extubation with regard to oxygenation indices and oxygen therapy utilization.ConclusionIn this sample of patients undergoing coronary artery bypass grafting, the use of different positive-end expiratory pressure levels before extubation did not affect gas exchange or oxygen therapy utilization in the first 6 h after endotracheal tube removal.

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Pressure support-ventilation versus spontaneous breathing with “T-Tube” for interrupting the ventilation after cardiac operations

Cited by 13 publications

References 25 publications

Spontaneous Breathing Trials With T-Piece or Pressure Support Ventilation

Spontaneous Breathing Trials With T-Piece or Pressure Support Ventilation

Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model

Relationship between pre-extubation positive end-expiratory pressure and oxygenation after coronary artery bypass grafting

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