Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece

Thille, Arnaud W.; Gacouin, Arnaud; Coudroy, Rémi; Ehrmann, Stéphan; Quenot, Jean-Pierre; Nay, Mai-Anh; Guitton, Christophe; Contou, Damien; Labro, Guylaine; Reignier, Jean; Pradel, Gaël; Béduneau, G.; Dangers, Laurence; Saccheri, Clément; Prat, Gwénaël; Lacave, Guillaume; Sédillot, Nicholas; Terzi, Nicolas; Combe, Béatrice La; Mira, Jean‐Paul; Romen, Antoine; Azais, Marie-Ange; Rouzé, Anahita; Devaquet, Jérôme; Delbove, Agathe; Dres, Martin; Bourenne, Jérémy; Lautrette, Alexandre; Keizer, Joe de; Ragot, Stéphanie; Frat, Jean‐Pierre

doi:10.1056/nejmoa2209041

Cited by 44 publications

(60 citation statements)

References 26 publications

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“…Spontaneous breathing trials are performed by leaving the patient to breathe with little or no positive end-expiratory pressure. This can be done by using either pressure-support ventilation or a T-piece [ 8 ]. When a patient is unable to tolerate a trial of spontaneous breathing, this is aborted, and assisted mechanical ventilation is resumed.…”

Section: Incidence Definition and Risk Factorsmentioning

confidence: 99%

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

Nicolotti

Grossi

Nicolini

et al. 2023

JCM

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Respiratory weaning after cardiac surgery can be difficult or prolonged in up to 22.7% of patients. The inability to wean from a ventilator within the first 48 h after surgery is related to increased short- and long-term morbidity and mortality. Risk factors are mainly non-modifiable and include preoperative renal failure, New York Heart Association, and Canadian Cardiac Society classes as well as surgery and cardio-pulmonary bypass time. The positive effects of pressure ventilation on the cardiovascular system progressively fade during the progression of weaning, possibly leading to pulmonary oedema and failure of spontaneous breathing trials. To prevent this scenario, some parameters such as pulmonary artery occlusion pressure, echography-assessed diastolic function, brain-derived natriuretic peptide, and extravascular lung water can be monitored during weaning to early detect hemodynamic decompensation. Tracheostomy is considered for patients with difficult and prolonged weaning. In such cases, optimal patient selection, timing, and technique may be important to try to reduce morbidity and mortality in this high-risk population.

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Section: Incidence Definition and Risk Factorsmentioning

confidence: 99%

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

Nicolotti

Grossi

Nicolini

et al. 2023

JCM

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“…Traditionally the Frequency/VT index (Rapid Shallow Breathing Index -RSB) is used to quantify the ventilatory autonomy capacity ideally on no ventilatory support through T-tube; but, considering that a recent clinical trial showed that there is no difference when using T-tube or PSV+CPAP/PEEP, 16 and given the high aerosolization capacity implied by the use of the T-tube, the exhaled air must be filtered, especially in contagious respiratory pathologies. The option for these cases would be:…”

Section: Spontaneous Breathing Trial (Sbt)mentioning

confidence: 99%

Mechanical ventilator liberation protocol. Recommendation based on review of the evidence

Aurio¹,

Alejandro²,

Rodrigo³

et al. 2023

JMV

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Mechanical ventilation is currently the most widely used supportive therapy for the treatment of moderate and severe hypoxemia of any etiology. However, the decision of "when" is the right time to initiate the withdrawal of this support is currently a matter of debate worldwide. Many authors describe that the disconnection process should be gradual and in compliance with standards that provide safety to this process; while other authors report that it is not feasible to establish a universal standard since each patient would have a unique behavior that would be difficult to establish in a protocolized manner. The present review represents an extensive search for evidence in an attempt to clarify this issue, generating evidence from a consensus of experts at international level, based on a broad review of the literature. Keywords: Weaning, Spontaneous breathing trial, Rapid shallow breathing index, P0.1

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“…Daher wurde durch Thille et al. eine multizentrische, randomisierte, kontrollierte Studie in Frankreich durchgeführt, um festzustellen, ob PSV-Versuche bei Patienten mit einem hohen Risiko für ein Scheitern der Extubation zu einer kürzeren Zeit bis zur Extubation führen können als T‑Stück-Versuche, ohne dabei ein höheres Risiko für eine erneute Intubation mit sich zu bringen [ 38 ].…”

Section: Introductionunclassified

“…In der Untersuchung aus dem Jahr 2022 lag der Prozentsatz der Patienten, bei denen eine Reintubation erforderlich war, in beiden Gruppen unter 15 %. Diese Prozentsätze sind niedriger als die, die normalerweise für Hochrisikopatienten angegeben werden [ 42 – 44 ], was darauf zurückzuführen sein könnte, dass fast 80 % der Patienten nach der Extubation eine prophylaktische nichtinvasive Beatmung erhielten [ 38 ]. Erwähnenswert ist noch, dass die Autoren zwar angeben, dass die Patienten wach und ruhig waren (Richmond Agitation and Sedation Scale (RASS) Score zwischen −2 und +1), aber spezifische Information über den Einsatz von sedierenden Medikation fehlen.…”

Section: Introductionunclassified