Extubation after breathing trials with automatic tube compensation, T‐tube, or pressure support ventilation

Abstract

After the inclusion of 90 patients (30 per group) we did not observe significant differences between the modes. Twelve patients failed the initial weaning trial. However, half of the patients who appeared to fail the spontaneous breathing trial on the T-tube, PSV, or both, were successfully extubated after a succeeding trial with ATC. Extubation was thus withheld from four and three of these patients while breathing with PSV or the T-tube, respectively, but to any patient breathing with ATC. It seems that ATC can be used as an alternative mode during the final phase of weaning from mechanical ventilation. Furthermore, this study may promote a larger multicenter trial on weaning with ATC compared with standard modes.

Tracheal ExtubationDiscussion

“…30,34 Automatic tube compensation, a ventilator setting that makes up for the pressure drop across the ETT, is comparable to low-level PSV or a T-piece. 35 The duration of an SBT should be at least 30 min 30 ; no benefit is gained from prolonging the duration of an SBT to 120 min. 36,37 The rate of weaning failure after an initial SBT has been reported to be 25-40%.…”

Effect of Inspiratory Muscle Training on Weaning Success in Critically Ill Intubated Patients

“…Similar data were recorded by Ezingeard et al (Ezingeard et al, 2006). However, Haberthur et al (2002) found no significant differences among the 3 protocols.…”

Potential Inadequacy of Automatic Tube Compensation to Decrease Inspiratory Work Load After at Least 48 Hours of Endotracheal Tube Use in the Clinical Setting

“…During spontaneous breathing, ATC compensates for the flow-dependent ⌬P ETT on the basis of the calculated pressure, not on the actual pressure measured at the distal end of the ETT. 7 The ⌬P ETT can be approximated with the following equation 8 :…”

“…17 In ATC mode, a ventilator measures flow and calculates the pressure required to overcome the flow-dependent resistive work load of the ETT. [5][6][7][8][9] The ATC calculations/algorithms are assuming a new, clean, and not deformed tube; because the calculation is based on the inner diameter and length of the ETT as well as on the measured flow, changes in the inner diameter of the ETT can hamper the accuracy of this calculation. Decrease in inner diameter induces increase in resistance, thus pressure drop is underestimated, and compensation is insufficient.…”

“…4 Automatic tube compensation (ATC) was developed to overcome the ETT-imposed respiratory work load. [5][6][7][8][9] ATC is designed to increase airway pressure by continuously calculating the pressure drop across the ETT (⌬P ETT ) during inspiration. [5][6][7][8][9] Theoretically, it simulates spontaneous breathing without the ETT, and appears to be suitable for use during the weaning period.…”