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

• Published in: PloS one Vol. 13; no. 8; p. e0202404
• Main Authors: Santos Pellegrini, José Augusto, Boniatti, Márcio Manozzo, Boniatti, Viviane Corrêa, Zigiotto, Crislene, Viana, Marina Verçoza, Nedel, Wagner Luiz, Marques, Leonardo da Silva, Dos Santos, Moreno Calcagnotto, de Almeida, Clarissa Balbão, Dal' Pizzol, Cláudia Pellizzer, Ziegelmann, Patrícia Klarmann, Rios Vieira, Sílvia Regina
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23-08-2018; Public Library of Science (PLoS)
• Subjects: Aged; Biology and Life Sciences; Breathing; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Clinical trials; Diagnosis; Disease control; Extubation; Female; Humans; Intensive care; Lung diseases; Male; Mechanical ventilation; Medicine and Health Sciences; Middle Aged; Obstructive lung disease; Patients; Physical Sciences; Positive-Pressure Respiration; Pressure; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Randomization; Research and Analysis Methods; Respiration; Respiratory therapy; Subgroups; Systematic review; Ventilation; Ventilator Weaning; Weaning; Brazil; Rio Grande do Sul Brazil; Montenegro
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0202404

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.
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.
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.
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.
ClinicalTrials.gov NCT01464567, at November 3, 2011.