Comparative Study between Automatic Tube Compensation (ATC) and Pressure Support Ventilation (PSV) as a Mode of Weaning from Mechanical Ventilation in Patients with Respiratory Failure

Abstract

Abstract Background Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube (ETT). Weaning from mechanical ventilation (MV) is a challenge. Its prolongation is related to increased mortality. Aim of the Work is to assess the value of ATC in predicting successful weaning and hastening the weaning process. This study will compare the benefits and effects of ATC versus PSV as weaning modes on spontaneous breathing trials and work of breathing. Patients and Mehtods This prospective non randomized was done on 50 adult patients admitted to the Critical Care Medicine Department in Ain shams University Hospital presenting with ARF and mechanically ventilated for at least 24 hours. They were divided into two groups: Group I “ATC group” Each underwent a 1-hour spontaneous breathing trial, using ATC mode and Group II “PSV group” PSV mode was used. Results In the present study we have found that the use of ATC during a spontaneous breathing trial was as effective as PSV in predicting the ability of patients to maintain spontaneous, unassisted breathing for more than 48 hours after removal of the endotracheal tube. In our study, there was no significant difference in the number of patients who tolerated the spontaneous breathing trial and then extubated between ATC and PSV groups (60 % vs. 56% respectively, p > 0.05). Both modes had comparable sensitivity, and +ve predictive value. Sensitivity was 80.0% versus 75.0% and the positive predictive value was 88.0%, versus 87.0% for ATC versus PSV respectively. The specificity was comparable (76.8% versus 80.0 % in ATC versus PSV respectively). ATC group had higher negative predictive than PSV group (82.0% versus 70.1%, respectively). In our study, criteria for successful extubation were met in 56.0%. In ATC group 60.0% met the criteria for successful extubation vs. 60% in PSV group. In the present study it was found that male patients were the most predominant in both groups (72.0% in ATC group and 68% in PSV group). This is expected as cigarette smoking is prevalent among males and is the single most important and most prevalent risk factor for the development of COPD. In our study, about one third of patients had COPD exacerbation as a cause for ARF. Conclusion In ICU population, ATC was safe, reliable, and can be reasonably used for weaning trials. ATC confers a potential benefit in weaning duration, weaning category, number of Ss, failure of first SBT extubation outcome, ICU length of stay, complication, and mortality rate. In addition, ATC improves the predictive value of RR/TV and IWI in predicting weaning success.