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JOURNAL CLUB: Pressure support vs T-piece for spontaneous breathing trials (SBT) in patients with high risk of extubation failure

By: Marcelo Alcantara, Médico - 02/02/2023 08:01

In a randomized, open-label, controlled, multicenter trial, Thille AW et al. compared PS vs. T-piece SBT in patients with a high risk of extubation failure.

It was published in the New England Journal of Medicine in November 2022.

🤔Hypothesis and study aim: Because the work of breathing needed during a PSV trial is lower than that required during a T-piece trial, PSV could shorten the time to extubation — but also increase the risk of reintubation, especially in patients with high risk for extubation failure. Therefore the authors compared PS vs. T-piece SBT in patients with a high risk of extubation failure.

👉The study was done in 31 ICUs in France from January 2020 through June 2021

👉Inclusion criteria: patients older than 65 or with any underlying
chronic cardiac or respiratory disease were considered ready to undergo
an initial SBT if they met standard weaning criteria.

👉Exclusion criteria: Patients admitted for traumatic brain injury, those with preexisting peripheral neuromuscular disease, and those with a do-not-reintubate order.

 👉They compared two types of SBT for approximately one-hour duration:

  • PS of 8cmH2O and zero PEEP
  • T-piece 

👉Primary outcomes: number of ventilator-free days from the initial SBT up to day 28th. Numerous secondary outcomes were analyzed and will be shown in the following posts on this topic.

👉 A total of 3975 were considered ready to undergo an initial SBT. Of these patients,1476 were eligible for inclusion, 983 underwent randomization, and 969 (484 in the PSV group and 485 in the T-piece group) were included. The characteristics of the patients at baseline were similar in the two groups, except for the higher percentage of women in the PSV group.

🧐 Main results, comments, and insights are available in the next post on this topic (only for subscribers).👇

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