Pressure-support ventilation or T-piece spontaneous breathing trials for patients with chronic obstructive pulmonary disease - A randomized controlled trial.

Autor: Santos Pellegrini JA; Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Boniatti MM; Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Boniatti VC; Intensive Care Unit, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil., Zigiotto C; Intensive Care Unit, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil., Viana MV; Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Intensive Care Unit, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil., Nedel WL; Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Intensive Care Unit, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil., Marques LDS; Intensive Care Unit, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil., Dos Santos MC; Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Intensive Care Unit, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil.; Intensive Care Unit, Hospital Montenegro, Montenegro, Brazil., de Almeida CB; Intensive Care Unit, Hospital Montenegro, Montenegro, Brazil., Dal' Pizzol CP; Intensive Care Unit, Hospital Montenegro, Montenegro, Brazil., Ziegelmann PK; Statistics Department and Post-Graduation Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Rios Vieira SR; Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2018 Aug 23; Vol. 13 (8), pp. e0202404. Date of Electronic Publication: 2018 Aug 23 (Print Publication: 2018).
DOI: 10.1371/journal.pone.0202404
Abstrakt: Background: Little 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.
Methods: Patients 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.
Results: Between 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.
Conclusions: The 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 Registration: ClinicalTrials.gov NCT01464567, at November 3, 2011.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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