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

José Augusto Santos Pellegrini, Márcio Manozzo Boniatti, Viviane Corrêa Boniatti, Crislene Zigiotto, Marina Verçoza Viana, Wagner Luiz Nedel, Leonardo da Silva Marques, Moreno Calcagnotto Dos Santos, Clarissa Balbão de Almeida, Cláudia Pellizzer Dal' Pizzol, Patrícia Klarmann Ziegelmann, Sílvia Regina Rios Vieira, José Augusto Santos Pellegrini, Márcio Manozzo Boniatti, Viviane Corrêa Boniatti, Crislene Zigiotto, Marina Verçoza Viana, Wagner Luiz Nedel, Leonardo da Silva Marques, Moreno Calcagnotto Dos Santos, Clarissa Balbão de Almeida, Cláudia Pellizzer Dal' Pizzol, Patrícia Klarmann Ziegelmann, Sílvia Regina Rios Vieira

Abstract

Background: 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.

Trial registration: ClinicalTrials.gov NCT01464567, at November 3, 2011.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Patients enrollment and randomization.
Fig 1. Patients enrollment and randomization.

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Source: PubMed

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