Abstract
Background
Pressure support ventilation (PSV) mode and T-piece trial were used in weaning of mechanically ventilated (MV) patients with chronic obstructive pulmonary disease (COPD). Thus, the objective of study is to assess the value of adding T-piece trial to PSV mode in weaning off patients with COPD.
Patients and methods
A total of 80 MV patients with COPD admitted to respiratory ICU were divided into two groups: group I included 40 patients who were weaned off by PSV mode and group II included 40 patients who were weaned off by PSV mode and T-piece trial.
Results
The mean age of patients was 62 years. Overall, 73.8% were males and 73.75% were smokers. There were no significant differences between both groups regarding age, sex, BMI, smoking status, Acute Physiology and Chronic Health Evaluation score, exacerbation frequency, and hospital admission. Moreover, there was no significant differences between both groups regarding vital capacity, negative inspiratory force, rapid shallow breathing index, partial arterial oxygen pressure, partial arterial carbon dioxide pressure, and arterial oxygen saturation at the end of PSV mode in both groups. A significant decline in partial arterial oxygen pressure and arterial oxygen saturation and increase in partial arterial carbon dioxide pressure were observed in group II patients after adding T-piece trial. A total of 34 (85%) patients were successfully extubated in group I, whereas 33 (82.5%) patients were successfully extubated in group II. Period of MV, duration of weaning, ICU stay, and mortality were significantly higher in group II patients.
Conclusion
T-piece trial after PSV mode has no role in weaning; moreover, it causes more complications and leads to longer duration of weaning.
Article PDF
Similar content being viewed by others
References
Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006; 28: 523–532.
Budweiser S, Jörres RA, Pfeifer M. Treatment of respiratory failure in COPD. Int J Chron Obstruct Pulmon Dis 2008; 2008: 605.
Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M, et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med 2006; 174: 894–900.
Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J 2007; 29: 1033–1056.
Epstein S. Decision to extubate. Intensive Care Med 2002; 28: 535–546.
Hammad ET, Suzan S, Safaa W, Hassan B. Automatic tube compensation versus pressure support ventilation as a weaning mode: does it make a difference? Egypt J Bronchol 2015; 9: 253–260.
Knaus WA, Draper EA, Wagner DP. A severity of disease classification system. Crit Care Med 1985; 13: 818–829.
BouAkl I, Bou-Khalil P, Kanazi G, Ayoub C, El-Khatib M. Weaning from mechanical ventilation. Curr Opin Anaesthesiol 2012; 25: 42–47.
Brochard L, LeBouche F. Pressure-support ventilation. In: Tobin M, editor. Principles and practice of mechanical ventilation. New York, NY: McGraw-Hill Professional; 2007. pp. 221–250.
Funk GC, Anders S, Breyer MK, Burghuber OC, Edelmann G, Heindl W, et al. Incidence and outcome of weaning from mechanical ventilation according to new categories. Eur Respir J 2010; 35: 88–94.
Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Manino DM. Global burden of COPD: systemic review and meta analysis. Eur Respir J 2006; 28: 523–532.
Van Durme YMTA, Verhamme KMC, Stijnen T, van Rooij FJA, Van Pottelberge GR, Hofman A, et al. Prevalence, incidence, and lifetime risk for the development of COPD in the elderly: the Rotterdam study. Chest 2009; 135: 368–377.
Kuhlen R, Max M, Dembinski R, Terbeck S, Jürgens E, Rossaint R. Breathing pattern and workload during automatic tube compensation, pressure support and T-piece trials in weaning patients. Eur J Anaesthesiol 2003; 20: 10–16.
Brochard L, Rua F, Lorino H, Lemaire F, Harf A. Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anesthesiology 1991; 75: 739–745.
Nathan SD, Ishaaya AM, Koerner SK, Belman MJ. Prediction of minimal pressure support during weaning from mechanical ventilation. Chest 1993; 103: 1215–1219.
Matić I, Davorin Đ, Višnja M, Matija J, Ivan M, Natalija M. Chronic obstructive pulmonary disease and weaning of difficult-to-wean patients from mechanical ventilation: randomized prospective study. Croat Med J 2007; 48: 51–58.
Brochard L. Pressure support is the preferred weaning method. Presented at: 5th International Consensus Conference in Intensive Care Medicine: weaning from mechanical ventilation. Budapest, Hungary: ERS, ATS, ESICM, SCCM, and SRL; 2005. 31: 28–29.
Ouf M, Ahmed F, Ahmed H, Ahmed E, Mohammed A. Electrolytes disturbances and their impact on mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease. Al-Azhar Assiut Med J 2015; 3: 27–34.
Esteban A, Inmaculada A, Federico G, Rafael F, Jose F, Inmaculada V, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med 1997; 156: 459–465.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Azouz, A.M., El-Sokary, R.T., El-Latif, H.A. et al. Pressure support ventilation mode versus pressure support ventilation+T-piece trial as a weaning modality in mechanically ventilated patients with chronic obstructive pulmonary disease. Egypt J Bronchol 13, 87–92 (2019). https://doi.org/10.4103/ejb.ejb_29_18
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/ejb.ejb_29_18