Comparison of Energy Expenditure and Oxygen Consumption of Spontaneous Breathing Trial Conducted With and Without Automatic Tube Compensation

Abstract

BackgroundWeaning from mechanical ventilation is defined as the process of release of ventilatory support and how the evaluation of this phase is conducted in the spontaneous breathing trial (SBT). One of the most used modes of SBT is the continuous positive airway pressure (CPAP), which applies a continuous positive pressure in both inspiration and expiration. However, together with the mechanical ventilation modes, the automatic tube compensation (ATC) can be used, which compensates the resistance imposed by the endotracheal tube. The objective of this study was to compare oxygen consumption (VO2) and energy expenditure (EE) during SBT conducted with and without ATC.MethodsThe study was prospective, randomized and crossover. Forty mechanically ventilated patients were admitted to an intensive care unit of a university tertiary hospital. The participants were randomly allocated in group 1, in which SBT was initiated with CPAP and ATC, followed by CPAP without ATC or in group 2, in which SBT was initiated with CPAP without ATC, followed by CPAP with ATC. Indirect calorimetry helped to measure VO2 and EE during SBT.ResultsThe differences between VO2 and EE obtained during SBT with ATC and without ATC were -1.6 mL/kg/min (95% CI: -4.36 - 1.07) and 5.4 kcal/day (95% CI: -21.67 - 10.79), respectively.ConclusionsWe concluded that VO2 and EE obtained during SBT with and without ATC were not different.

Role of Automatic Tube Compensation as Spontaneous Breathing Trial in Critically Ill Patients: A Systematic Review and Meta-Analysis

“…However, a recent meta-analysis revealed no significant difference in successful extubation rate between the T-piece and PS groups [19]. In recent years, ATC has been developed to assess the possibility of discontinuing mechanical ventilation [8], which was considered to have a similar mechanism with PSV [33]. However, different from PSV, the preset pressure of ATC model can be modified according to the conditions [34].…”

“…The mechanism of the ATC is to compensate the airway resistance caused by the trachea catheter, and eventually reduce the extra work of patients' autonomous respiration [8]. Some studies [9][10][11] suggested that ATC should be preferably prescribed to guide ventilator weaning in critically ill patients.…”

Comparative Efficacy and Safety of Four Different Spontaneous Breathing Trials for Weaning From Mechanical Ventilation: A Systematic Review and Network Meta-Analysis

“…At present, T-piece, continuous positive airway pressure (CPAP), pressure support ventilation (PSV), and automatic tube compensation (ATC) are the most common ventilation techniques (11,12,(15)(16)(17)(18)(19)(20). SBT strategies focused in this study can be categorized into three categories as follows: (a) providing constant or dynamic ventilatory support to counteract the resistance of the endotracheal tube such as PSV and ATC (21)(22)(23), (b) providing continuous positive pressure in both inspiration and expiration to enhance breathing mechanics and reduce the effort needed by mechanically ventilated patients with airflow obstruction such as CPAP (24)(25)(26)(27), and (c) accelerating spontaneous breath of patients without positive pressure support such as T-piece, which is related to more frequent respiratory activity and consumption of more oxygen (28,29).…”

Efeitos da fisioterapia com estimulação elétrica neuromuscular nas fases aguda e tardia do choque séptico e sepse. Ensaio clínico aleatorizado do tipo crossover

“…No presente estudo, a média destes valores foi entre 0,68 a 0,82, conferindo a confiabilidade das medidas. Para a obtenção de valores precisos, além do conhecimento técnico e da experiência prévia dos autores com calorimetria (AUXILIADORA-MARTINS et al, 2011;LAGO et al, 2015;PICOLO et al, 2016), alguns critérios recomendados foram seguidos, como a checagem de vazamentos dos gases respirados, a calibração, a exclusão de pacientes com drenos e fístulas, com frações inspiradas de oxigênio maior que 60% e da PEEP maior que 20 cmH2O. Apesar desta variável ter apresentado uma diferença estatística significativa, quando comparado os valores ente o repouso e a intervenção, nos pacientes em choque séptico (< 72 horas), este valor não tem significância clínica.…”