Am. J. Respir. Crit. Care Med., Volume 156, Number 2, August 1997, 459-465

Extubation Outcome after Spontaneous Breathing Trials with T-Tube or Pressure Support Ventilation

ANDRÉS ESTEBAN, INMACULADA ALÍA, FEDERICO GORDO, RAFAEL FERNÁNDEZ, JOSÉ F. SOLSONA, INMACULADA VALLVERDÚ, SANTIAGO MACÍAS, JOSÉ M. ALLEGUE, JESÚS BLANCO, DEMETRIO CARRIEDO, MIGUEL LEÓN, MIGUEL A. de la CAL, FRANCISCO TABOADA, JUAN GONZALEZ de VELASCO, EUGENIO PALAZÓN, FRANCISCO CARRIZOSA, ROSER TOMÁS, JOSÉ SUAREZ, and ROSANNE S. GOLDWASSER, for the Spanish Lung Failure Collaborative Group

From the Hospital Universitario de Getafe, Madrid; Hospital Parc Taulí, Sabadell; Hospital del Mar, Barcelona; Hospital Santa Creu i San Pau, Barcelona; Hospital General, Segovia; Hospital Santa María del Rosell, Cartagena; Hospital del Rio Hortega, Valladolid; Complejo Hospitalario, León; Hospital Arnau de Vilanova, Lleida; Hospital Central de Asturias, Oviedo; Hospital Josep Trueta, Gerona; Hospital Universitario, Murcia; Hospital de la Seguridad Social, Jerez; Hospital Hermanos Trias i Pujol, Badalona; Hospital Severo Ochoa, Leganés, Spain; and Hospital Clementino Fraga Filho, Rio de Janeiro, Brasil

A 2-h T-tube trial of spontaneous breathing was used in selecting patients ready for extubation and discontinuation of mechanical ventilation. However, some doubt remains as to whether it is the most appropriate method of performing a spontaneous breathing trial. We carried out a prospective, randomized, multicenter study involving patients who had received mechanical ventilation for more than 48 h and who were considered by their physicians to be ready for weaning according to clinical criteria and standard weaning parameters. Patients were randomly assigned to undergo a 2-h trial of spontaneous breathing in one of two ways: with a T-tube system or with pressure support ventilation of 7 cm H₂O. If a patient had signs of poor tolerance at any time during the trial, mechanical ventilation was reinstituted. Patients without these features at the end of the trial were extubated. Of the 246 patients assigned to the T-tube group, 192 successfully completed the trial and were extubated; 36 of them required reintubation. Of the 238 patients in the group receiving pressure support ventilation, 205 were extubated and 38 of them required reintubation. The percentage of patients who remained extubated after 48 h was not different between the two groups (63% T-tube, 70% pressure support ventilation, p = 0.14). The percentage of patients failing the trial was significantly higher when the T-tube was used (22 versus 14%, p = 0.03). Clinical evolution during the trial was not different in patients reintubated and successfully extubated. ICU mortality among reintubated patients was significantly higher than in successfully extubated patients (27 versus 2.6%, p < 0.001). Spontaneous breathing trials with pressure support or T-tube are suitable methods for successful discontinuation of ventilator support in patients without problems to resume spontaneous breathing.

This article has been cited by other articles:

				T. Unoki, A. Serita, and M. J. Grap Automatic Tube Compensation During Weaning From Mechanical Ventilation: Evidence and Clinical Implications Crit. Care Nurse, August 1, 2008; 28(4): 34 - 42. [Full Text] [PDF]

				J-M. Boles, J. Bion, A. Connors, M. Herridge, B. Marsh, C. Melot, R. Pearl, H. Silverman, M. Stanchina, A. Vieillard-Baron, et al. Weaning from mechanical ventilation Eur. Respir. J., May 1, 2007; 29(5): 1033 - 1056. [Abstract] [Full Text] [PDF]

				G. Hernandez, R. Fernandez, E. Luzon, R. Cuena, and J. C. Montejo The Early Phase of the Minute Ventilation Recovery Curve Predicts Extubation Failure Better Than the Minute Ventilation Recovery Time Chest, May 1, 2007; 131(5): 1315 - 1322. [Abstract] [Full Text] [PDF]

				T. D. Girard and G. R. Bernard Mechanical Ventilation in ARDS: A State-of-the-Art Review Chest, March 1, 2007; 131(3): 921 - 929. [Abstract] [Full Text] [PDF]

				F. Frutos-Vivar, N. D. Ferguson, A. Esteban, S. K. Epstein, Y. Arabi, C. Apezteguia, M. Gonzalez, N. S. Hill, S. Nava, G. D'Empaire, et al. Risk Factors for Extubation Failure in Patients Following a Successful Spontaneous Breathing Trial Chest, December 1, 2006; 130(6): 1664 - 1671. [Abstract] [Full Text] [PDF]

				K. E.A. Burns, N. K.J. Adhikari, and M. O. Meade A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation: [Une meta-analyse d'un sevrage non effractif pour faciliter le retrait de la ventilation mecanique]. Can J Anesth, March 1, 2006; 53(3): 305 - 315. [Abstract] [Full Text] [PDF]

				C. A. Manthous, Y. Amoateng-Adjepong, H. E. Fessler, and J. A. Krishnan Weaning by Protocol Am. J. Respir. Crit. Care Med., July 1, 2004; 170(1): 98 - 100. [Full Text]

				A. Esteban, F. Frutos-Vivar, N. D. Ferguson, Y. Arabi, C. Apezteguia, M. Gonzalez, S. K. Epstein, N. S. Hill, S. Nava, M.-A. Soares, et al. Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation N. Engl. J. Med., June 10, 2004; 350(24): 2452 - 2460. [Abstract] [Full Text] [PDF]

				J. D. Truwit Viewpoints to Liberation From Mechanical Ventilation Chest, June 1, 2003; 123(6): 1779 - 1780. [Full Text] [PDF]

				A. G. Randolph, D. Wypij, S. T. Venkataraman, J. H. Hanson, R. G. Gedeit, K. L. Meert, P. M. Luckett, P. Forbes, M. Lilley, J. Thompson, et al. Effect of Mechanical Ventilator Weaning Protocols on Respiratory Outcomes in Infants and Children: A Randomized Controlled Trial JAMA, November 27, 2002; 288(20): 2561 - 2568. [Abstract] [Full Text] [PDF]

				M. Ferrer, O. Bernadich, S. Nava, and A. Torres Noninvasive ventilation after intubation and mechanical ventilation Eur. Respir. J., May 1, 2002; 19(5): 959 - 965. [Abstract] [Full Text] [PDF]

				A. Esteban, A. Anzueto, F. Frutos, I. Alia, L. Brochard, T. E. Stewart, S. Benito, S. K. Epstein, C. Apezteguia, P. Nightingale, et al. Characteristics and Outcomes in Adult Patients Receiving Mechanical Ventilation: A 28-Day International Study JAMA, January 16, 2002; 287(3): 345 - 355. [Abstract] [Full Text] [PDF]

				E. W. Ely, A. P. Wheeler, B. T. Thompson, M. Ancukiewicz, K. P. Steinberg, G. R. Bernard, and for the Acute Respiratory Distress Syndrome Networ Recovery Rate and Prognosis in Older Persons Who Develop Acute Lung Injury and the Acute Respiratory Distress Syndrome Ann Intern Med, January 1, 2002; 136(1): 25 - 36. [Abstract] [Full Text] [PDF]

				N. R. MacIntyre Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support : A Collective Task Force Facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine Chest, December 1, 2001; 120(6_suppl): 375S - 396S. [Abstract] [Full Text] [PDF]

				M. Meade, G. Guyatt, L. Griffith, L. Booker, J. Randall, and D. J. Cook Introduction to a Series of Systematic Reviews of Weaning From Mechanical Ventilation* Chest, December 1, 2001; 120(6_suppl): 396S - 399S. [Full Text] [PDF]

				M. Meade, G. Guyatt, D. Cook, L. Griffith, T. Sinuff, C. Kergl, J. Mancebo, A. Esteban, and S. Epstein Predicting Success in Weaning From Mechanical Ventilation Chest, December 1, 2001; 120(6_suppl): 400S - 424S. [Abstract] [Full Text] [PDF]

				M. Meade, G. Guyatt, T. Sinuff, L. Griffith, L. Hand, G. Toprani, and D. J. Cook Trials Comparing Alternative Weaning Modes and Discontinuation Assessments Chest, December 1, 2001; 120(6_suppl): 425S - 437S. [Abstract] [Full Text] [PDF]

				E. W. Ely, M. O. Meade, E. F. Haponik, M. H. Kollef, D. J. Cook, G. H. Guyatt, and J. K. Stoller Mechanical Ventilator Weaning Protocols Driven by Nonphysician Health-Care Professionals : Evidence-Based Clinical Practice Guidelines Chest, December 1, 2001; 120(6_suppl): 454S - 463S. [Abstract] [Full Text] [PDF]

				D. Hess Ventilator Modes Used in Weaning Chest, December 1, 2001; 120(6_suppl): 474S - 476S. [Abstract] [Full Text] [PDF]

				S. K. Epstein Predicting Extubation Failure : Is It in (on) the Cards? Chest, October 1, 2001; 120(4): 1061 - 1063. [Full Text] [PDF]

				M. Khamiees, P. Raju, A. DeGirolamo, Y. Amoateng-Adjepong, and C. A. Manthous Predictors of Extubation Outcome in Patients Who Have Successfully Completed a Spontaneous Breathing Trial Chest, October 1, 2001; 120(4): 1262 - 1270. [Abstract] [Full Text] [PDF]

				M. L. Nevins and S. K. Epstein Predictors of Outcome for Patients With COPD Requiring Invasive Mechanical Ventilation Chest, June 1, 2001; 119(6): 1840 - 1849. [Abstract] [Full Text] [PDF]

				P. C. Hebert, M. A. Blajchman, D. J. Cook, E. Yetisir, G. Wells, J. Marshall, and I. Schweitzer Do Blood Transfusions Improve Outcomes Related to Mechanical Ventilation? Chest, June 1, 2001; 119(6): 1850 - 1857. [Abstract] [Full Text] [PDF]

				S. Edmunds, I. Weiss, and R. Harrison Extubation Failure in a Large Pediatric ICU Population Chest, March 1, 2001; 119(3): 897 - 900. [Abstract] [Full Text] [PDF]

				S. K. EPSTEIN, M. L. NEVINS, and J. CHUNG Effect of Unplanned Extubation on Outcome of Mechanical Ventilation Am. J. Respir. Crit. Care Med., June 1, 2000; 161(6): 1912 - 1916. [Abstract] [Full Text]

				A. ESTEBAN, A. ANZUETO, I. ALÍA, F. GORDO, C. APEZTEGUÍA, F. PÁLIZAS, D. CIDE, R. GOLDWASER, L. SOTO, G. BUGEDO, et al. How Is Mechanical Ventilation Employed in the Intensive Care Unit? . An International Utilization Review Am. J. Respir. Crit. Care Med., May 1, 2000; 161(5): 1450 - 1458. [Abstract] [Full Text]

				N. BOCQUILLON, D. MATHIEU, R. NEVIERE, N. LEFEBVRE, X. MARECHAL, and F. WATTEL Gastric Mucosal pH and Blood Flow during Weaning from Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., November 1, 1999; 160(5): 1555 - 1561. [Abstract] [Full Text]

				C. GIRAULT, I. DAUDENTHUN, V. CHEVRON, F. TAMION, J. LEROY, and G. BONMARCHAND Noninvasive Ventilation as a Systematic Extubation and Weaning Technique in Acute-on-Chronic Respiratory Failure . A Prospective, Randomized Controlled Study Am. J. Respir. Crit. Care Med., July 1, 1999; 160(1): 86 - 92. [Abstract] [Full Text]

				A. ESTEBAN, I. ALÍA, M. J. TOBIN, A. GIL, F. GORDO, I. VALLVERDÚ, L. BLANCH, A. BONET, A. VÁZQUEZ, R. de PABLO, et al. Effect of Spontaneous Breathing Trial Duration on Outcome of Attempts to Discontinue Mechanical Ventilation Am. J. Respir. Crit. Care Med., February 1, 1999; 159(2): 512 - 518. [Abstract] [Full Text]

				I. VALLVERDU, N. CALAF, M. SUBIRANA, A. NET, S. BENITO, and J. MANCEBO Clinical Characteristics, Respiratory Functional Parameters, and Outcome of a Two-Hour T-Piece Trial in Patients Weaning from Mechanical Ventilation Am. J. Respir. Crit. Care Med., December 1, 1998; 158(6): 1855 - 1862. [Abstract] [Full Text] [PDF]

				S. K. EPSTEIN and R. L. CIUBOTARU Independent Effects of Etiology of Failure and Time to Reintubation on Outcome for Patients Failing Extubation Am. J. Respir. Crit. Care Med., August 1, 1998; 158(2): 489 - 493. [Abstract] [Full Text] [PDF]