Comparison of Proportional Assist Ventilation Plus, T-Tube Ventilation, and Pressure Support Ventilation as Spontaneous Breathing Trials for Extubation: A Randomized Study.

Autor:	Nogueira Teixeira, Sandy, Osaku, Erica Fernanda, de Macedo Costa, Claudia Rejane Lima, Fernandes Toccolini, Beatriz, Lamberti Costa, Nicolle, Cândia, Maria Fernanda, Aparecida Leite, Marcela, Jorge, Amaury Cezar, Delfino Duarte, Péricles Almeida
Předmět:	ANALYSIS of variance ARTIFICIAL respiration BRAIN injuries CHI-squared test CONFIDENCE intervals LENGTH of stay in hospitals PROBABILITY theory RESPIRATORY insufficiency RESPIRATORY therapy STATISTICAL sampling STATISTICS MECHANICAL ventilators LOGISTIC regression analysis RANDOMIZED controlled trials TREATMENT effectiveness EXTUBATION DATA analysis software DESCRIPTIVE statistics ODDS ratio KRUSKAL-Wallis Test
Zdroj:	Respiratory Care; Nov2015, Vol. 60 Issue 11, p1527-1535, 9p, 3 Diagrams, 4 Charts
Abstrakt:	BACKGROUND: Failure to wean can prolong ICU stay, increase complications associated with mechanical ventilation, and increase morbidity and mortality. The spontaneous breathing trial (SBT) is one method used to assess weaning. The aim of this study was to assess proportional assist ventilation plus (PAV+) as an SBT by comparing its applicability, safety, and efficacy with T-tube and pressure support ventilation (PSV). METHODS: A randomized study was performed involving 160 adult subjects who remained on mechanical ventilation for > 24 h. Subjects were randomly assigned to the PAY+, PSV, or T-tube group. When subjects were ready to perform the SBT, subjects in the PAV+ group were ventilated in PAV+ mode (receiving support of up to 40%), the pressure support was reduced to 7 cm H2O in the PSV group, and subjects in the T-tube group were connected to one T-piece with supplemental oxygen. Subjects were observed for signs of intolerance, whereupon the trial was interrupted. When the trial succeeded, the subjects were extubated and assessed until discharge. RESULTS: The subjects were predominantly male (66.5%), and the leading cause of admission was traumatic brain injury. The groups were similar with respect to baseline characteristics, and no significant difference was observed among the groups regarding extubation success or failure. Analysis of the specificity and sensitivity revealed good sensitivity for all groups; however, the PAV+ group had higher specificity (66.6%) and higher sensitivity (97.6%), with prediction of ~92.1% of the success and failure events. CONCLUSIONS: No significant differences in the groups was observed regarding the rate of extubation failure, duration of mechanical ventilation, and ICU and hospital stay, indicating that PAV+ is an alternative for use as an SBT. [ABSTRACT FROM AUTHOR]
Databáze:	Supplemental Index
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