Automatic tube compensation versus pressure support ventilation as a weaning mode: does it make a difference?

Abstract

Background Automatic tube compensation (ATC) is one of the newer weaning modes that seem promising to improve the weaning process.Objective To evaluate the benefit of ATC in hastening and improving the weaning process. Patients and methodsIn a prospective randomizedcontrolled trial, all eligible patients of Assiut Chest Department who were mechanically ventilated were included during the period from April 2010 to March 2012. They were divided into two groups, 88 patients weaned by pressure support ventilation (PSV) and 78 patients weaned by ATC. The primary outcomes measure was the ability to maintain spontaneous breathing for more than 48 h after extubation and weaning duration.Results A total of 166 patients were included; the mean age was 58.6 ± 12.3 years; males represented 70%. The weaning duration was shorter in ATC than in PSV (19.7 vs. 29.9 h, respectively). Also, ATC had a higher trend toward successful extubation than PSV (88.5 vs. 78.4%). Patients who underwent weaning by ATC had a nonsignificant trend toward simple weaning. Moreover, hospital mortality was less in ATC (ATC 15.4% vs. PSV 22.7%). However, the difference did not reach significance in all primary and secondary outcomes. ConclusionIn respiratory ICU patients, the weaning process can be usefully performed by ATC (at least as effective as PSV) but without significant hastening of the weaning process. All primary and secondary outcomes were potentially improved (weaning duration, extubation outcome, predictive value of ATC-assisted ratio of respiratory rate and tidal volume, number of spontaneous breathing trials, weaning category, reintubation rate, complications, and hospital mortality).

Spontaneous Breathing Trial Techniques for Extubating Adults and Children Who Are Critically Ill

“…Of the 19 studies further assessed for eligibility, 9 were excluded (Figure 1). In addition to 31 previously included trials, we identified 10 new full publications, including 1 full publication that replaced a previously included abstract publication. Of the 40 trials included (n = 6797 randomized and n = 6716 patients with outcomes), 9 were new trials (n = 3130 patients analyzed), 6 trials compared 3 SBT techniques (but for 1 of the 3-arm trials, the 5-cm H 2 O and 10-cm H 2 O CPAP groups were combined for a single comparison with the third T-piece group), and 1 trial compared 4 SBT techniques (Table 1).…”

“…Only 2 trials (5.0%) assessed outcomes in a blinded manner. Twenty-one trials (52.5%) were judged to have complete outcomes reporting, including 6 new trials . Finally, 27 trials (67.5%) conducted an intention-to-treat analysis, and 33 trials (82.5%) did not stop early for benefit.…”

“…Twenty-one trials (52.5%) were judged to have complete outcomes reporting, including 6 new trials . Finally, 27 trials (67.5%) conducted an intention-to-treat analysis, and 33 trials (82.5%) did not stop early for benefit. Overall trial quality was moderate (eFigure in Supplement 1).…”

“…There was no association of 1 SBT technique compared with another on ICU mortality, hospital mortality, or the most protracted mortality measure. One trial each reported time to first SBT and time to successful extubation . There was no association of the alternative SBT techniques on ICU or hospital LOS and rates of tracheostomy and noninvasive ventilation and HFO use after extubation (eTable 3 in Supplement 1).…”

“…Twenty-one trials (52.5%) 30, 31, 40-44, 46-49, 52, 53, 59, 60, 62-65, 67, 69 were judged to have complete outcomes reporting, including 6 new trials. [62][63][64][65]67,69 Finally, 27 trials (67.5%)…”