This is an outdated version published on 2023-12-18. Read the most recent version.

Comparison of Endotracheal Extubation Effectiveness Between the use of Pressure Support Ventilation and T-piece Ventilation During the Spontaneous Breathing Trial of Intubated and Mechanically Ventilated Patients

Authors

Siripong Chaiwattanatrakul Nong Bua Lamphu Hospital
Jitrada Pimsri Nong Bua Lamphu Hospital

Keywords:

weaning, Extubation succeed, LOS, ventilator weaning

Abstract

Patients who use ventilators should consider stopping using ventilators when their symptoms improve. This study aims to test breathing after intubation through two methods: pressure support ventilation and T-type ventilation.

Objective: To compare the effectiveness of endotracheal extubation between pressure support and T-piece modes during spontaneous breathing trial

Design, location, and patients: Intervention research (Observation cohort design) to collect prospective data collection in a group of patients with respiratory failure who are intubated and entering the phase of weaning from mechanical ventilation. Received treatment at the medical intensive care unit.

Measurement and methods: General characteristics of general data chi-square test, independent t-test, main outcome measure, successful extubation of the endotracheal tube, were compared in both groups with Risk difference

Results: 315 intubated patients who entered the phase of weaning from mechanical ventilation, 218 cases in the Mode pressure support ventilation group, 97 cases in the T-piece weaning group, with an average age of 60.1 (± 17.1) , 60.9 (±14.7) SOS score at first admission averaged 5.3 (± 1.3) , 5.2(± 1.3) respectively. Comparing the success of the PSV and T-Piece self-breathing test methods, it was found that there was a proportion of Extubation. The success rates were 96.8% and 89.7%, respectively. When adjusting for the influence of gender, age, and comorbidities, the PSV method had a 7% (95% CI: 0.00 to 0.14) higher chance of success than the T-Piece method, but the difference was not statistically significant (p-value 0.051)

Conclusion and use: The PSV method of self-breathing testing before removing the endotracheal tube has a higher chance of success than the T-Piece. Therefore, the PSV method can be used because it is convenient for the operator. and reduce time spent practicing breathing.

References

Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kell PT, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335(25):1864-9.

Girard TD, Kress JP, Fuchs BD, Thomason J-WW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008;371(9607):126-34.

Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implication of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161(5):1530-6.

Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997;112(1):186-92.

Thille AW, Richard J-CM, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013;187(12):1294-302.

Schmidt GA, Girard TD, Kress JP, Morris PE, Ouellette DR, Alhazzani W, et al. Official executive summary of an American Thoracic Society/American College of Chest Physicians clinical practice guideline: liberation from mechanical ventilation in critically ill adults. Am J Respir Crit Care Med. 2017;195(1):115-9.

Béduneau G, Pham T, Schortgen F, Piquilloud L, Zogheib E, Jonas M, et al. Epidemiology of weaning Outcome according to a New Defni‑tion. The WIND Study. Am J Respir Crit Care Med. 2017;195:(6)772–83.

Subirà C, Hernández G, Vázquez A, Rodríguez-García R, González-Castro A, García C, et al. Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA. 2019;321(22):2175–82.

Jeon K, Jeong BH, Ko MG, Nam J, Yoo H, Chung CR, et al. Impact of delirium on weaning from mechanical ventilation in medical patients. Respirology. 2016;21(2):313–20.

Esteban A, Alía I, Gordo F, Fernández R, Solsona JF, Vallverdú I, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med. 1997;156(2 pt1):459-65.

Matić I, Majerić-Kogler V. Comparison of pressure support and T-tube weaning from mechanical ventilation: randomized prospective study. Croat Med J. 2004;45(2):162-6.

Ezingeard E, Diconne E, Guyomarc'h S, Venet C, Page D, Gery P, et al. Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing. Intensive Care Med. 2006;32(1):165-9.

Sklar MC, Burns K, Rittayamai N, Lanys A, Rauseo M, Chen L, et al. Effort to breathe with various spontaneous breathing trial techniques: a physiologic meta-analysis. Am J Respir Crit Care Med. 2017;195(11):1477-85.

Tobin MJ. Extubation and the myth of “minimal ventilator settings”. Am J Respir Crit Care Med. 2012;185(4):349-50.

Santos Pellegrini JA, Boniatti MM, Boniatti VC, Zigiotto C, Viana MV, Nedel WL, et al. Pressuresupport ventilation or T-piece spontaneous breathing trials for patients with chronic obstructive pulmonary disease - A randomized controlled trial. PloS one. 2018;13(8):e0202404.