Purpose

Spontaneous breathing trials (SBT) evaluate the patient's capacity to maintain inspiratory effort after extubation. SBT practices are heterogeneous and not individualised. The objective of this study was to assess which SBT best reproduces inspiratory effort after extubation in five critical illnesses.

Methods

In this multicentre randomized cross-over study, adult intensive care unit patients under invasive mechanical ventilation for at least 24-h and ready for extubation, underwent three 15-min SBTs in random order: pressure support ventilation level of 7-cmH₂O with positive end-expiratory pressure (PEEP) level of 0-cmH₂O (PSV7PEEP0), PSV 0-cmH₂O with PEEP 0-cmH₂O (PSV0PEEP0) and T-piece trial. Primary outcome was the variation of pressure–time-product per minute (PTPmin) between each SBT and 20-min after extubation. Five categories of critical illnesses were selected: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease (COPD) and miscellaneous.

Results

Five hundred measures of effort from 100 patients were analysed. PTPmin (cmH₂O s/min, median and interquartile range, IQR) was 256 (208–321) after extubation, 192 (127–281) at the end of PSV7PEEP0 (p < 0.001 in comparison to after extubation), 291 (235–347) at the end of PSV0PEEP0 and 262 (198–338) at the end of T-piece (both no different from after extubation). One method of SBT in patients with brain injury (PSV0PEEP0), two in abdominal surgery (PSV0PEEP0 and T-piece) and miscellaneous patients (PSV7PEEP0 and T-piece) and all three methods in chest trauma and COPD exacerbation patients replicated reasonably accurately the postextubation effort to breathe.

Conclusion

Unassisted SBTs, namely PSV0PEEP0 and T-piece trial, are the most appropriate to replicate the postextubation effort to breathe.

中文翻译：

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应根据危重疾病为每位患者调整自主呼吸试验。一种新的个体化方法：GLOBAL WEAN 研究

 目的

自主呼吸试验 （SBT） 评估患者拔管后维持吸气努力的能力。SBT 实践是异质性的，而不是个体化的。本研究的目的是评估哪种 SBT 最能再现 5 种危重疾病拔管后的吸气努力。

 方法

在这项多中心随机交叉研究中，接受有创机械通气至少 24 小时并准备拔管的成年重症监护病房患者以随机顺序接受了 3 次 15 分钟的 SBT：压力支持通气水平为 7-cmH₂O，呼气末正压 （PEEP） 水平为 0-cmH₂O （PSV7PEEP0），PSV 0-cmH₂O 与 PEEP 0-cmH₂O （PSV0PEEP0） 和 T 型试制。主要结局是每次 SBT 和拔管后 20 min 之间每分钟压力-时间-产物 （PTPmin） 的变化。选择了 5 类危重疾病：腹部手术、脑损伤、胸部外伤、慢性阻塞性肺疾病 （COPD） 和其他疾病。

 结果

分析了 100 名患者的 500 项努力措施。PTPmin （cmH₂O s/min，中位数和四分位数间距，IQR） 拔管后为 256 （208–321），PSV7PEEP0 结束时为 192 （127–281）（与拔管后相比 p < 0.001），PSV0PEEP0 结束时为 291 （235–347），T 型件末端为 262 （198–338）（均与拔管后无差别）。一种用于脑损伤 （PSV0PEEP0） 患者的 SBT 方法，两种用于腹部手术 （PSV0PEEP0 和 T 型） 和其他患者 （PSV7PEEP0 和 T 型） 以及胸部创伤和 COPD 恶化患者的所有三种方法都合理准确地复制了拔管后呼吸的努力。

 结论

无辅助 SBT，即 PSV0PEEP0 和 T 型试验，最适合复制拔管后呼吸的努力。