Background: Reconnection to the ventilator for 1 h following a successful spontaneous breathing trial (SBT) may reduce reintubation rates compared with direct extubation. However, the physiologic mechanisms leading to this effect are unclear.
Research Question: Does reconnection to the ventilator for 1 h reverse alveolar derecruitment induced by SBT, and is alveolar derecruitment more pronounced with a T-piece than with pressure-support ventilation (PSV)?
Study Design And Methods: This is an ancillary study of a randomized clinical trial comparing SBT performed with a T-piece or with PSV. Alveolar recruitment was assessed by using measurement of end-expiratory lung volume (EELV).
Results: Of the 25 patients analyzed following successful SBT, 11 underwent SBT with a T-piece and 14 with PSV. At the end of the SBT, EELV decreased by -30% (95% CI, -37 to -23) compared with baseline prior to the SBT. This reduction was greater with a T-piece than with PSV: -43% (95% CI, -51 to -35) vs -20% (95% CI, -26 to -13); P < .001. Following reconnection to the ventilator for 1 h, EELV accounted for 96% (95% CI, 92 to 101) of baseline EELV and did not significantly differ from prior to the SBT (P = .104). Following 10 min of reconnection to the ventilator, EELV wasted at the end of the SBT was completely recovered using PSV (P = .574), whereas it remained lower than prior to the SBT using a T-piece (P = .010).
Interpretation: Significant alveolar derecruitment was observed at the end of an SBT and was markedly more pronounced with a T-piece than with PSV. Reconnection to the ventilator for 1 h allowed complete recovery of alveolar derecruitment.
Clinical Trial Registration: ClinicalTrials.gov; No.: NCT04227639; URL: www.
Clinicaltrials: gov.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.chest.2024.01.038 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Weaning of non COPD patients at high-risk of extubation failure assessed by lung ultrasound: the WIN IN WEAN multicentre randomised controlled trial.
Crit Care
November 2024
Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France.
Background: Postextubation respiratory failure (PRF) frequently complicates weaning from mechanical ventilation and may increase morbidity/mortality. Noninvasive ventilation (NIV) alternating with high-flow nasal oxygen (HFNO) may prevent PRF.
Methods: Ventilated patients without chronic obstructive pulmonary disease (COPD) and at high-risk of PRF defined as a lung ultrasound score (LUS) ≥ 14 assessed during the spontaneous breathing trial, were included in a French-Chinese randomised controlled trial.
Spontaneous breathing trials: how and for how long?
Curr Opin Crit Care
February 2025
Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation.
Purpose Of Review: Guidelines recommend systematic performance of a spontaneous breathing trial (SBT) before extubation in ICUs, the objective being to reduce the risk of reintubation. In theory, a more challenging SBT performed with a T-piece may further reduce the risk of reintubation, whereas a less challenging SBT performed with pressure-support ventilation (PSV) may hasten extubation.
Recent Findings: Recent findings show that a more challenging SBT with a T-piece or for a prolonged duration do not help to reduce the risk of reintubation.
Detection of spontaneous breathing during an apnea test in a patient with suspected brain death using electrical impedance tomography: a case report.
BMC Pulm Med
September 2024
Institute of Technical Medicine, Hochschule Furtwangen, Jakob-Kienzle-Str. 17, Villingen-Schwenningen, 78054, Germany.
Article Synopsis
- The apnea test (AT) is important for confirming brain death and typically involves disconnecting the patient from a ventilator to observe spontaneous breathing, though visual checks can sometimes miss subtle movements.
- A case study of a morbidly obese 55-year-old man undergoing the AT revealed that using electrical impedance tomography (EIT) alongside visual observation led to identifying spontaneous breathing, resulting in the test being discontinued.
- The study concludes that EIT may improve the accuracy and sensitivity of detecting breathing efforts during the AT, allowing for better assessment of a patient's respiratory status.
Anesthetic Techniques for Ablation in Atrial Fibrillation: A Comparative Review.
J Cardiothorac Vasc Anesth
November 2024
Banner University Medical Center, Department of Anesthesiology and Pain Medicine, University of Arizona COM-T, Tucson, Arizona. Electronic address:
Atrial fibrillation, the most prevalent cardiac arrhythmia, has witnessed significant advancements in treatment modalities, transitioning from invasive procedures like the maze procedure to minimally invasive catheter ablation techniques. This review focuses on recent improvements in anesthetic approaches that enhance outcomes in catheter atrial fibrillation ablation. We highlight the efficacy of contact force sensing catheters with steerable introducer sheaths, which outperform traditional catheters by ensuring more effective contact time and lesion formation.
View Article and Find Full Text PDFReconnecting to Improve Liberation From Mechanical Ventilation: A New Perspective.
Chest
June 2024
University of California Irvine, Irvine, CA; MemorialCare, Long Beach Medical Center, Long Beach, CA. Electronic address:
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!