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Intensive Care Medicine

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01.07.2010 | Original

Physiological comparison of three spontaneous breathing trials in difficult-to-wean patients

verfasst von: Belén Cabello, Arnaud W. Thille, Ferran Roche-Campo, Laurent Brochard, Francisco J. Gómez, Jordi Mancebo

Erschienen in: Intensive Care Medicine | Ausgabe 7/2010

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Abstract

Purpose

To compare cardiovascular and respiratory responses to different spontaneous breathing trials (SBT) in difficult-to-wean patients using T-piece and pressure support ventilation (PSV) with or without positive end-expiratory pressure (PEEP).

Methods

Prospective physiological study. Fourteen patients who were monitored with a Swan-Ganz catheter and had failed a previous T-piece trial were studied. Three SBTs were performed in random order in all patients: PSV with PEEP (PSV-PEEP), PSV without PEEP (PSV-ZEEP), and T-piece. PSV level was 7 cmH₂O, and PEEP was 5 cmH₂O. Inspiratory muscle effort was calculated, and hemodynamic parameters were measured using standard methods.

Results [median (and interquartile range)]

Most patients succeeded in the PSV-PEEP (11/14) and PSV-ZEEP (8/14) trials, but all failed the T-piece trial. Patient effort was significantly higher during T-piece than during PSV with or without PEEP [esophageal pressure-time product was 292 (238–512), 128 (58–299), and 148 (100–465) cmH₂O·s/min, respectively, p < 0.05]. Left ventricular heart failure was observed in 11 of the 14 patients during the T-piece trial. Pulmonary artery occlusion pressure and respiratory rate were significantly higher during T-piece than with PSV-PEEP [21 (18–24) mmHg versus 17 (14–22) mmHg, p < 0.05 and 27 (21–35) breaths/min versus 19 (16–29) breaths/min, p < 0.05 respectively]. Tidal volume was significantly lower during the T-piece trial.

Conclusion

In this selected population of difficult-to-wean patients, PSV and PSV plus PEEP markedly modified the breathing pattern, inspiratory muscle effort, and cardiovascular response as compared to the T-piece. Caregivers should be aware of these differences in SBT as they may play an important role in weaning decision-making.

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Titel: Physiological comparison of three spontaneous breathing trials in difficult-to-wean patients
verfasst von: Belén Cabello
Arnaud W. Thille
Ferran Roche-Campo
Laurent Brochard
Francisco J. Gómez
Jordi Mancebo
Publikationsdatum: 01.07.2010
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 7/2010
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-1870-0

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