Citation Information :
Meghalakshmi AR, Vasudevan A. Comparison of Extubation Outcomes Following T-piece Trial versus Pressure Support/Continous Positive Airway Pressure in Postsurgical Patients. Indian J Respir Care 2018; 7 (1):37-41.
Background: Pressure support with continuous positive airway pressure (CPAP) and T-piece trials are the most common spontaneous breathing trial used to test readiness for extubation.
Aim: We aimed to compare extubation failures defined by the need for reintubation within 48 h following T-piece trial versus extubation directly from pressure support (PS) ventilation in postoperative patients.
Patients and Methods: This was a prospective cross-sectional study conducted in the postsurgical patients. Hemodynamic parameters and respiratory variables were measured before and after weaning trials. Outcomes after extubation, need for noninvasive-assist ventilation following extubation, duration of oxygen therapy, and time of shifting from the Intensive Care Unit (ICU) were also recorded.
Results: Fifty patients needed mechanical ventilation postoperatively were recruited for the study. No significant differences were seen in the rate of extubation failures between PS- and T-piece groups. Rapid shallow breathing index recorded at the start of weaning was significantly higher in the T-piece group (P < 0.001). The respiratory rate (RR) and heart rate (HR) were significantly higher (P < 0.001) and saturation lower (P = 0.035) in the group on T-piece trial. The need for respiratory assist devices, oxygenation index, length of ICU stay, duration of oxygen therapy, and mortality were comparable between the two groups.
Conclusions: Outcomes of weaning are similar between T piece and CPAP/PS in patients undergoing postoperative mechanical ventilation. Weaning on T piece is associated with higher RR, HR, rapid shallow breathing, and lower saturation than weaning from CPAP/PS but does not affect the length of ICU stay, need for oxygen therapy, or mortality.
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. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1997;156:459-65.
Alía I, Esteban A. Weaning from mechanical ventilation. Crit Care 2000;4:72-80.
Matic I, Majeric-Kogler V. Comparison of pressure support and T-tube weaning from mechanical ventilation: Randomized prospective study. Croat Med J 2004;45:162-6.
Esteban A, Alía I, Tobin MJ, Gil A, Gordo F, Vallverdú I, et al. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1999;159:512-8.
Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994;150:896-903.
Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998;158:489-93.
Haberthür C, Mols G, Elsasser S, Bingisser R, Stocker R, Guttmann J, et al. Extubation after breathing trials with automatic tube compensation, T-tube, or pressure support ventilation. Acta Anaesthesiol Scand 2002;46:973-9.
Conti G, Montini L, Pennisi MA, Cavaliere F, Arcangeli A, Bocci MG, et al. A prospective, blinded evaluation of indexes proposed to predict weaning from mechanical ventilation. Intensive Care Med 2004;30:830-6.
Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324:1445-50.
Tobin MJ, Jubran A. Variable performance of weaning-predictor tests: Role of Bayes’ theorem and spectrum and test-referral bias. Intensive Care Med 2006;32:2002-12.
Haas CF, Loik PS. Ventilator discontinuation protocols. Respir Care 2012;57:1649-62.
Ladeira MT, Vital FM, Andriolo RB, Andriolo BN, Atallah AN, Peccin MS, et al. Pressure support versus T-tube for weaning from mechanical ventilation in adults. Cochrane Database Syst Rev 2014;2014;(5). Art No.:CD006056.
Papaioannou VE, Chouvarda I, Maglaveras N, Dragoumanis C, Pneumatikos I. Changes of heart and respiratory rate dynamics during weaning from mechanical ventilation: A study of physiologic complexity in surgical critically ill patients. J Crit Care 2011;26:262-72.
Glossop AJ, Shephard N, Bryden DC, Mills GH. Non-invasive ventilation for weaning, avoiding reintubation after extubation and in the postoperative period: A meta-analysis. Br J Anaesth 2012;109:305-14.
Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 2001;120:1262-70.
Salam A, Tilluckdharry L, Amoateng-Adjepong Y, Manthous CA. Neurologic status, cough, secretions and extubation outcomes. Intensive Care Med 2004;30:1334-9.
Girard TD, Kress JP, Fuchs BD, Thomason JW, 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;371:126-34.
