Title :

Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece

Author(s) :

Thille, Arnaud W. [Auteur]
Gacouin, Arnaud [Auteur]
Coudroy, Rémi [Auteur]
Ehrmann, Stephan [Auteur]
Quenot, Jean-Pierre [Auteur]
Nay, Mai-Anh [Auteur]
Guitton, Christophe [Auteur]
Contou, Damien [Auteur]
Labro, Guylaine [Auteur]
Reignier, Jean [Auteur]
Pradel, Gael [Auteur]
Beduneau, Gaëtan [Auteur]
Dangers, Laurence [Auteur]
Saccheri, Clement [Auteur]
Prat, Gwénaël [Auteur]
Lacave, Guillaume [Auteur]
Sedillot, Nicholas [Auteur]
Terzi, Nicolas [Auteur]
La Combe, Béatrice [Auteur]
Mira, Jean-Paul [Auteur]
Romen, Antoine [Auteur]
Azais, Marie-Ange [Auteur]
Rouze, Anahita [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 [UGSF]
Devaquet, Jérôme [Auteur]
Delbove, Agathe [Auteur]
Dres, Martin [Auteur]
Bourenne, Jeremy [Auteur]
Lautrette, Alexandre [Auteur]
de Keizer, Joe [Auteur]
Ragot, Stéphanie [Auteur]
Frat, Jean-Pierre [Auteur]

Journal title :

New England Journal of Medicine

Abbreviated title :

N Engl J Med

Volume number :

387

Pages :

1843-1854

Publisher :

Massachusetts Medical Society

Publication date :

2022-11-17

ISSN :

0028-4793

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

BACKGROUND Spontaneous-breathing trials can be performed with the use of either pressure- support ventilation (PSV) or a T-piece. Whether PSV trials may result in a shorter time to tracheal extubation than T-piece trials, ...
Show more >BACKGROUND Spontaneous-breathing trials can be performed with the use of either pressure- support ventilation (PSV) or a T-piece. Whether PSV trials may result in a shorter time to tracheal extubation than T-piece trials, without resulting in a higher risk of reintubation, among patients who have a high risk of extubation failure is un- known. METHODS In this multicenter, open-label trial, we randomly assigned patients who had a high risk of extubation failure (i.e., were >65 years of age or had an underlying chronic cardiac or respiratory disease) to undergo spontaneous-breathing trials performed with the use of either PSV (with a pressure-support level of 8 cm of water and no positive end-expiratory pressure) or a T-piece. The primary outcome was the total time without exposure to invasive ventilation (reported as the number of ventilator-free days) at day 28 after the initial spontaneous-breathing trial. Secondary outcomes included extubation within 24 hours and extubation within 7 days after the initial spontaneous-breathing trial, as well as reintubation within 7 days after extubation. RESULTS A total of 969 patients (484 in the PSV group and 485 in the T-piece group) were included in the analysis. At day 28, the median number of ventilator-free days was 27 (interquartile range, 24 to 27) in the PSV group and 27 (interquartile range, 23 to 27) in the T-piece group (difference, 0 days; 95% confidence interval [CI], −0.5 to 1; P = 0.31). Extubation was performed within 24 hours in 376 patients (77.7%) in the PSV group and in 350 patients (72.2%) in the T-piece group (difference, 5.5 per- centage points; 95% CI, 0.01 to 10.9), and extubation was performed within 7 days in 473 patients (97.7%) and 458 patients (94.4%), respectively (difference, 3.3 per- centage points; 95% CI, 0.8 to 5.9). Reintubation was performed in 72 of 481 pa- tients (14.9%) in the PSV group and in 65 of 477 patients (13.6%) in the T-piece group (difference, 1.3 percentage points; 95% CI, −3.1 to 5.8). Cardiac or respira- tory arrest was a reason for reintubation in 9 patients (3 in the PSV group and 6 in the T-piece group). CONCLUSIONS Among patients who had a high risk of extubation failure, spontaneous-breathing trials performed with PSV did not result in significantly more ventilator-free days at day 28 than spontaneous-breathing trials performed with a T-piece. (Supported by the French Ministry of Health; TIP-EX ClinicalTrials.gov number, NCT04227639.)Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CNRS

Collections :

• Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576

Research team(s) :

Glycobiology in fungal Pathogenesis and Clinical Applications

Submission date :

2024-02-27T14:26:43Z
2024-03-01T09:59:18Z