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Authors: Pellegrini, José Augusto Santos
Boniatti, Márcio Manozzo
Boniatti, Viviane Corrêa
Zigiotto, Crislene
Viana, Marina Verçoza
Nedel, Wagner Luiz
Marques, Leonardo da Silva
dos Santos, Moreno Calcagnotto
Almeida, Clarissa Balbão de
Dal’Pizzol, Cláudia Pellizzer
Ziegelmann, Patrícia Klarmann
Vieira, Sílvia Regina Rios
Title: Pressure-support ventilation or T-piece spontaneous breathing trials for patients with chronic obstructive pulmonary disease: a randomized controlled trial
Other Titles: PELLEGRINI, J. A. S. et al. Pressure-support ventilation or T-piece spontaneous breathing trials for patients with chronic obstructive pulmonary disease: a randomized controlled trial. PLoS ONE, v. 13, n. 8, p. 1-14, 2018. Disponível em: Acesso em: 13 set. 2021.
Keywords: Pressure-support ventilation;Chronic Obstructive Pulmonary Disease;Intensive Care Unit
Issue Date: 2018
Publisher: PLoS ONE
Abstract: ackground 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.
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