OBJECTIVE: Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial. DESIGN AND SETTING: This was a prospective, non-randomized study in two French intensive care units. PATIENTS AND PARTICIPANTS: One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87 were extubated. Thirty-one underwent a further trial with PS, after which 21 were extubated. INTERVENTIONS: All patients under MV >24 h meeting the criteria for a weaning test underwent a 30-min T-tube trial. If this was successful, they were immediately extubated. Otherwise, a 30-min trial with +7 cm H2O PS was initiated with an individualized pressurization slope and trigger adjustment. If all weaning criteria were met, the patients were extubated; otherwise, MV was reinstated. MEASUREMENTS AND RESULTS: The extubation failure rate at 48 h did not differ significantly between the groups: 11/87 (13%) versus 4/21 (19%), P=0.39. The groups were comparable with regard to endotracheal tube diameter, MV duration, the use of non-invasive ventilation (NIV) after extubation, initial severity score, age and underlying pathology, except for COPD. A significantly higher percentage of patients with COPD was extubated after the trial with PS (8/21-38%) than after a single T-tube trial (11/87-13%) (P=0.003). CONCLUSIONS: Of the patients, 21/118 (18%) could be extubated after a trial with PS, despite having failed a T-tube trial. The reintubation rate was not increased. This protocol may particularly benefit patients who are most difficult to wean, notably those with COPD.
OBJECTIVE: Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial. DESIGN AND SETTING: This was a prospective, non-randomized study in two French intensive care units. PATIENTS AND PARTICIPANTS: One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87 were extubated. Thirty-one underwent a further trial with PS, after which 21 were extubated. INTERVENTIONS: All patients under MV >24 h meeting the criteria for a weaning test underwent a 30-min T-tube trial. If this was successful, they were immediately extubated. Otherwise, a 30-min trial with +7 cm H2OPS was initiated with an individualized pressurization slope and trigger adjustment. If all weaning criteria were met, the patients were extubated; otherwise, MV was reinstated. MEASUREMENTS AND RESULTS: The extubation failure rate at 48 h did not differ significantly between the groups: 11/87 (13%) versus 4/21 (19%), P=0.39. The groups were comparable with regard to endotracheal tube diameter, MV duration, the use of non-invasive ventilation (NIV) after extubation, initial severity score, age and underlying pathology, except for COPD. A significantly higher percentage of patients with COPD was extubated after the trial with PS (8/21-38%) than after a single T-tube trial (11/87-13%) (P=0.003). CONCLUSIONS: Of the patients, 21/118 (18%) could be extubated after a trial with PS, despite having failed a T-tube trial. The reintubation rate was not increased. This protocol may particularly benefit patients who are most difficult to wean, notably those with COPD.
Authors: A Esteban; I Alía; F Gordo; R Fernández; J F Solsona; I Vallverdú; S Macías; J M Allegue; J Blanco; D Carriedo; M León; M A de la Cal; F Taboada; J Gonzalez de Velasco; E Palazón; F Carrizosa; R Tomás; J Suarez; R S Goldwasser Journal: Am J Respir Crit Care Med Date: 1997-08 Impact factor: 21.405
Authors: P Aslanian; S El Atrous; D Isabey; E Valente; D Corsi; A Harf; F Lemaire; L Brochard Journal: Am J Respir Crit Care Med Date: 1998-01 Impact factor: 21.405
Authors: J A Farias; A Retta; I Alía; F Olazarri; A Esteban; A Golubicki; D Allende; O Maliarchuk; C Peltzer; M E Ratto; R Zalazar; M Garea; E G Moreno Journal: Intensive Care Med Date: 2001-10 Impact factor: 17.440
Authors: G Bonmarchand; V Chevron; C Chopin; D Jusserand; C Girault; F Moritz; J Leroy; P Pasquis Journal: Intensive Care Med Date: 1996-11 Impact factor: 17.440
Authors: Magdaline T Ladeira; Flávia M R Vital; Régis B Andriolo; Brenda N G Andriolo; Alvaro N Atallah; Maria S Peccin Journal: Cochrane Database Syst Rev Date: 2014-05-27
Authors: Carles Subirà; Gonzalo Hernández; Antònia Vázquez; Raquel Rodríguez-García; Alejandro González-Castro; Carolina García; Olga Rubio; Lara Ventura; Alexandra López; Maria-Carmen de la Torre; Elena Keough; Vanesa Arauzo; Cecilia Hermosa; Carmen Sánchez; Ana Tizón; Eva Tenza; César Laborda; Sara Cabañes; Victoria Lacueva; Maria Del Mar Fernández; Anna Arnau; Rafael Fernández Journal: JAMA Date: 2019-06-11 Impact factor: 56.272