Extubation Outcome after Spontaneous Breathing Trials  with T-Tube or Pressure Support Ventilation

Esteban, Andrés; Alía, Inmaculada; Gordo, Federico; Fernàndez, R.; Solsona, José F.; Vallverdú, I.; Macías, Santiago; Allegue, J.M.; Blanco, Jesús; Carriedo, Demetrio; León, Montserrat; Cal, Miguel A. de la; Taboada, Francisco; Velasco, J.; Palazón, Eugenio L.; Carrizosa, F; Tomàs, Roser Boix; Suárez, J.-C.; Goldwasser, Rosane

doi:10.1164/ajrccm.156.2.9610109

Cited by 638 publications

(476 citation statements)

References 24 publications

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“…A utilização desses protocolos tem diminuído o tempo de VM, a duração de internação na UTI, o custo total da internação e mesmo a mortalidade [14][15][16] . A melhor forma de realizar essa tentativa de ventilação espontânea não está ainda definida 12 . O teste com tubo T se mostrou de fácil execução, pelo curto período de aplicação, mas sua utilização exige monitorização contínua.…”

Section: Resultsunclassified

“…O teste com tubo T se mostrou de fácil execução, pelo curto período de aplicação, mas sua utilização exige monitorização contínua. Nessa casuística, mostrou-se eficaz em cerca de 80% dos casos, semelhante a dados da literatura 10,12 .…”

Section: Resultsunclassified

“…Entretanto, a taxa de re-intubação foi elevada, visto que na literatura ela varia entre 14% e 20% 12,17 . Isso pode ser conseqüência do tempo de tubo T, que levaria os pacientes a um esforço por tempo excessivo com possível comprometimento da função muscular.…”

Section: Resultsunclassified

“…Entretanto, esses critérios são semelhantes aos usualmente utilizados em outros estudos 9,10 , inclusive sendo mais rigorosos, visto a freqüência respiratória permitida ser até 30 irpm e não 35 como descrito em outros estudos. A re-intubação está associada à aumento de mortalidade, como já foi demonstrada em diversos estudos 12,[17][18][19] . Isso provavelmente é secundário ao próprio estado clínico do paciente e não ao ato mecânico da re-intubação, pois os pacientes que foram re-intubados por problemas de obstrução não terem sua mortalidade alterada 18 .…”

Section: Resultsunclassified

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Avaliação de teste de tubo T como estratégia inicial de suspensão da ventilação mecânica

Assunção¹,

Machado²,

Rosseti³

et al. 2006

Rev. bras. ter. intensiva

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Section: Resultsunclassified

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Avaliação de teste de tubo T como estratégia inicial de suspensão da ventilação mecânica

Assunção¹,

Machado²,

Rosseti³

et al. 2006

Rev. bras. ter. intensiva

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“…2 Weaning accounts for 41% and 60% of the total ventilatory time in mixed, medicalsurgical ICU populations and in populations with chronic obstructive pulmonary disease (COPD), respectively. 3 Over the past decade, clinical investigations have focused on strategies to limit the duration of ventilation, for example, early identification of patients who are likely to be weaned, [4][5][6] tests of readiness to resume spontaneous breathing trials (SBTs), [7][8][9] and strategies to reduce support in patients who fail a SBT. [10][11][12] Several modes and techniques have been used to liberate critically ill adults from invasive mechanical ventilation.…”

Section: Résumémentioning

confidence: 99%

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Burns

Lellouche²,

Slutsky

et al. 2009

Can J Anesth/J Can Anesth

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Purpose To determine the stated practices of clinicians in weaning critically ill adults from invasive ventilation. Methods We conducted a cross-sectional, self-administered postal survey of Critical Care physicians and respiratory therapists (RTs) in leadership roles at Canadian teaching hospitals. We identified respondents using electronic mail and telephone correspondence. We used rigorous survey methodology to develop, test, and administer the questionnaire.Results One hundred ten of 162 (67.9%) clinicians returned the survey with 99 respondents (55 physicians and 44 RTs) completing it either in-part or in-full. Approximately 95% of respondents acknowledged ever performing spontaneous breathing trials (SBTs) in clinical practice. Of these, 95.6% and 32% of respondents reported conducting daily and twice-daily screening to identify SBT candidates, at least sometimes. The three most common techniques to conduct SBTs included; pressure support (PS) with positive end-expiratory pressure (70.8%), continuous positive airway pressure (35.7%), and use of a T-piece (25.0%). PS ventilation was the weaning strategy used most frequently before SBTs. Most respondents (57.1%) considered continuous infusion of sedative-hypnotics to be a relative contraindication to tracheal extubation. However, concurrent administration of low dose vasopressors, inotropes, and analgesic boluses, or continuous analgesic infusions were considered acceptable amongst 60.8%, 73.2%, 78.4% -009-9124-8 and 58.8% of respondents, respectively. We did not observe regional variation in whether clinicians ever perform SBTs, the ventilatory modes used prior to an SBT nor in the use of PS and SBTs during the weaning process. Conclusions Pressure support and SBTs are common features of weaning in Canadian teaching hospitals. Compared to the published literature, our survey suggests that weaning practices have evolved over time and that practice variation may be greater on an international level compared to a national level.123 Can J Anesth/J Can Anesth (2009) 56:567-576 DOI 10.1007/s12630 RésuméObjectif De´terminer les pratiques de´clare´es des cliniciens concernant le sevrage des patients adultes gravement malades de la ventilation invasive. Méthode Nous avons re´alise´un sondage transversal, auto-administre´et envoye´par courrier aupre`s des me´decins des soins critiques et des inhalothe´rapeutes occupant des positions de leadership dans les hôpitaux d'enseignement canadiens. Nous avons identifie´les re´pondants a`l'aide de correspondance par courrier e´lectronique et par te´le´phone. Nous avons utilise´une me´thodologie de sondage rigoureuse afin d'e´laborer, de tester et d'administrer le questionnaire. Résultats Sur un total de 162 cliniciens, 110 (67,9%) ont renvoye´le questionnaire; 99 re´pondants (55 me´decins et 44 inhalothe´rapeutes) ont comple´te´le questionnaire en entier ou en partie. Environ 95 % des re´pondants ont reconnu qu'ils re´alisaient des tests de ventilation spontane´e (TVS) dans leur pratique clinique. Parmi ceux-ci, 9...

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Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure

Perkins

Mistry

Gates

et al. 2018

JAMA

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In adults in whom weaning from invasive mechanical ventilation is difficult, noninvasive ventilation may facilitate early liberation, but there is uncertainty about its effectiveness in a general intensive care patient population. OBJECTIVE To investigate among patients with difficulty weaning the effects of protocolized weaning with early extubation to noninvasive ventilation on time to liberation from ventilation compared with protocolized invasive weaning. DESIGN, SETTING, AND PARTICIPANTS Randomized, allocation-concealed, open-label, multicenter clinical trial enrolling patients between March 2013 and October 2016 from 41 intensive care units in the UK National Health Service. Follow-up continued until April 2017. Adults who received invasive mechanical ventilation for more than 48 hours and in whom a spontaneous breathing trial failed were enrolled. INTERVENTIONS Patients were randomized to receive either protocolized weaning via early extubation to noninvasive ventilation (n = 182) or protocolized standard weaning (continued invasive ventilation until successful spontaneous breathing trial, followed by extubation) (n = 182). MAIN OUTCOMES AND MEASURES Primary outcome was time from randomization to successful liberation from all forms of mechanical ventilation among survivors, measured in days, with the minimal clinically important difference defined as 1 day. Secondary outcomes were duration of invasive and total ventilation (days), reintubation or tracheostomy rates, and survival. RESULTS Among 364 randomized patients (mean age, 63.1 [SD, 14.8] years; 50.5% male), 319 were evaluable for the primary effectiveness outcome (41 died before liberation, 2 withdrew, and 2 were discharged with ongoing ventilation). The median time to liberation was 4.3 days in the noninvasive group vs 4.5 days in the invasive group (adjusted hazard ratio, 1.1; 95% CI, 0.89-1.40). Competing risk analysis accounting for deaths had a similar result (adjusted hazard ratio, 1.1; 95% CI, 0.86-1.34). The noninvasive group received less invasive ventilation (median, 1 day vs 4 days; incidence rate ratio, 0.6; 95% CI, 0.47-0.87) and fewer total ventilator days (median, 3 days vs 4 days; incidence rate ratio, 0.8; 95% CI, 0.62-1.0). There was no significant difference in reintubation, tracheostomy rates, or survival. Adverse events occurred in 45 patients (24.7%) in the noninvasive group compared with 47 (25.8%) in the invasive group. CONCLUSIONS AND RELEVANCE Among patients requiring mechanical ventilation in whom a spontaneous breathing trial had failed, early extubation to noninvasive ventilation did not shorten time to liberation from any ventilation.

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Extubation Outcome after Spontaneous Breathing Trials with T-Tube or Pressure Support Ventilation

Cited by 638 publications

References 24 publications

Avaliação de teste de tubo T como estratégia inicial de suspensão da ventilação mecânica

Avaliação de teste de tubo T como estratégia inicial de suspensão da ventilação mecânica

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure

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