Abstract
BackgroundRecent guidelines recommended conducting spontaneous breathing trial (SBT) with modest inspiratory pressure augmentation rather than T-piece or continuous positive airway pressure. However, it was based on few studies focused on the outcomes of extubation rather than the weaning process, despite the existence of various weaning situations in clinical practice. This study was designed to investigate the effects of SBT with pressure support ventilation (PSV) or T-piece on weaning outcomes.MethodsAll consecutive patients admitted to two medical intensive care units (ICUs) and those requiring mechanical ventilation (MV) for more than 24 h from November 1, 2017 to September 30, 2020 were prospectively registered. T-piece trial was used until March 2019, and then, pressure support of 8 cmH2O and 0 positive end-expiratory pressure were used for SBT since July 2019, after a 3-month transition period for the revised SBT protocol. The primary outcome of this study was successful weaning defined according to the WIND (Weaning according to a New Definition) definition and were compared between the T-piece group and PSV group. The association between the SBT method and weaning outcome was evaluated with logistic regression analysis.ResultsIn this study, 787 eligible patients were divided into the T-piece (n = 473) and PSV (n = 314) groups after excluding patients for a 3-month transition period. Successful weaning was not different between the two groups (85.0% vs. 86.3%; p = 0.607). However, the PSV group had a higher proportion of short weaning (70.1% vs. 59.0%; p = 0.002) and lower proportion of difficult weaning (13.1% vs. 24.1%; p < 0.001) than the T-piece group. The proportion of prolonged weaning was similar between the two groups (16.9% vs. 16.9%; p = 0.990). After excluding patients who underwent tracheostomy before the SBTs, similar results were found. Reintubation rates at 48 h, 72 h, and 7 days following the planned extubation were not different between the PSV and T-piece groups. Moreover, no significant differences in intensive care unit and hospital mortality and length of stay were observed.ConclusionsIn critically ill medical patients, SBT using PSV was not associated with a higher rate of successful weaning compared with SBT using T-piece. However, PSV could shorten the weaning process without increasing the risk of reintubation.
Highlights
Recent guidelines recommended conducting spontaneous breathing trial (SBT) with modest inspira‐ tory pressure augmentation rather than T-piece or continuous positive airway pressure
All consecutive patients admitted to two medical intensive care units (ICUs) and those requiring mechanical ventilation (MV) for more than 24 h from November 2017 were prospectively registered at Samsung Medical Center (a 1989-bed tertiary referral hospital with tertiary-level Intensive care unit (ICU)) in Seoul, South Korea
The rates of heart failure and myopathies/neuropathies were higher in the pressure support ventilation (PSV) group than those in the T-piece group
Summary
Recent guidelines recommended conducting spontaneous breathing trial (SBT) with modest inspira‐ tory pressure augmentation rather than T-piece or continuous positive airway pressure. It was based on few studies focused on the outcomes of extubation rather than the weaning process, despite the existence of various weaning situations in clinical practice. Recent guidelines recommended conducting SBT with modest inspiratory pressure augmentation rather than without inspiratory pressure support, such as T-piece [6] We reported that the WIND classification applies to all mechanically ventilated patients, regardless of the type of artificial airway, and has a higher discriminatory power for weaning outcomes [9]
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