Abstract
BackgroundLittle is known about the best strategy for weaning patients with chronic obstructive pulmonary disease (COPD) from mechanical ventilation. Spontaneous breathing trials (SBT) using a T-piece or pressure-support ventilation (PSV) have a central role in this process. Our aim was to compare T-piece and PSV SBTs according to the duration of mechanical ventilation (MV) in patients with COPD.MethodsPatients with COPD who had at least 48 hours of invasive MV support were randomized to 30 minutes of T-piece or PSV at 10 cm H2O after being considered able to undergo a SBT. All patients were preemptively connected to non-invasive ventilation after extubation. Tracheostomized patients were excluded. The primary outcome was total invasive MV duration. Time to liberation from MV was assessed as secondary outcome.ResultsBetween 2012 and 2016, 190 patients were randomized to T-piece (99) or PSV (91) groups. Extubation at first SBT was achieved in 78% of patients. The mean total MV duration was 10.82 ± 9.1 days for the T-piece group and 7.31 ± 4.9 days for the PSV group (p < 0.001); however, the pre-SBT duration also differed (7.35 ± 3.9 and 5.84 ± 3.3, respectively; p = 0.002). The time to liberation was 8.36 ± 11.04 days for the T-piece group and 4.06 ± 4.94 for the PSV group (univariate mean ratio = 2.06 [1.29–3.27], p = 0.003) for the subgroup of patients with difficult or prolonged weaning. The study group was independently associated with the time to liberation in this subgroup.ConclusionsThe SBT technique did not influence MV duration for patients with COPD. For the difficult/prolonged weaning subgroup, the T-piece may be associated with a longer time to liberation, although this should be clarified by further studies.Trial registrationClinicalTrials.gov NCT01464567, at November 3, 2011.
Highlights
Weaning of patients with chronic obstructive pulmonary disease (COPD) from mechanical ventilation remains a fundamental goal, it is a difficult task
For the difficult/ prolonged weaning subgroup, the T-piece may be associated with a longer time to liberation, this should be clarified by further studies
[5] These can be performed through a variety of methods, but low levels of pressure-support ventilation (PSV) and T-piece comprise between 30% and 50% of the Spontaneous breathing trials (SBT) employed
Summary
Weaning of patients with COPD from mechanical ventilation remains a fundamental goal, it is a difficult task. [6] Recent guidelines suggest that PSV should be the initial choice when performing SBTs in patients who have been ventilated for more than 24 hours, [7] this is not required for the COPD population. Our group recently published a systematic review with a meta-analysis of trials that compared PSV to a T-piece to wean patients from mechanical ventilation. Our primary objective was to compare the use of the T-piece and PSV for SBTs in terms of the total MV duration in patients with COPD who were being weaned from MV after being ventilated for more than 48 hours. Our aim was to compare T-piece and PSV SBTs according to the duration of mechanical ventilation (MV) in patients with COPD
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
