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Bruno Louis - One of the best experts on this subject based on the ideXlab platform.
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Low-pressure support vs automatic tube compensation during Spontaneous Breathing Trial for weaning
Annals of Intensive Care, 2019Co-Authors: Claude Guerin, Nicolas Terzi, Mehdi Mezidi, Loredana Baboi, Hodane Yonis, Nader Chebib, Laurent Argaud, Leo M. A. Heunks, Bruno LouisAbstract:Background During Spontaneous Breathing Trial, low-pressure support is thought to compensate for endotracheal tube resistance, but it actually should provide overassistance. Automatic tube compensation is an option available in the ventilator to compensate for flow-resistance of endotracheal tube. Its effects on patient effort have been poorly investigated. We aimed to compare the effects of low-pressure support and automatic tube compensation during Spontaneous Breathing Trial on Breathing power and lung ventilation distribution. Results We performed a randomized crossover study in 20 patients ready to wean. Each patient received both methods for 30 min separated by baseline ventilation: pressure support 0 cmH_2O and automatic tube compensation 100% in one period and pressure support 7 cmH_2O without automatic tube compensation in the other period, a 4 cmH_2O positive end-expiratory pressure being applied in each. Same ventilator brand (Evita XL, Draeger, Germany) was used. Breathing power was assessed from Campbell diagram with esophageal pressure, airway pressure, flow and volume recorded by a data logger. Lung ventilation distribution was assessed by using electrical impedance tomography (Pulmovista, Draeger, Germany). During the last 2 min of low-pressure support and automatic compensation period Breathing power and lung ventilation distribution were measured on each breath. Breathing power generated by the patient’s respiratory muscles was 7.2 (4.4–9.6) and 9.7 (5.7–21.9) J/min in low-pressure support and automatic tube compensation periods, respectively ( P = 0.011). Lung ventilation distribution was not different between the two methods. Conclusions We found that ATC was associated with higher Breathing power than low PS during SBT without altering the distribution of lung ventilation.
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Low-pressure support vs automatic tube compensation during Spontaneous Breathing Trial for weaning.
Annals of intensive care, 2019Co-Authors: Claude Guerin, Nicolas Terzi, Mehdi Mezidi, Loredana Baboi, Hodane Yonis, Nader Chebib, Laurent Argaud, Leo M. A. Heunks, Bruno LouisAbstract:During Spontaneous Breathing Trial, low-pressure support is thought to compensate for endotracheal tube resistance, but it actually should provide overassistance. Automatic tube compensation is an option available in the ventilator to compensate for flow-resistance of endotracheal tube. Its effects on patient effort have been poorly investigated. We aimed to compare the effects of low-pressure support and automatic tube compensation during Spontaneous Breathing Trial on Breathing power and lung ventilation distribution. We performed a randomized crossover study in 20 patients ready to wean. Each patient received both methods for 30 min separated by baseline ventilation: pressure support 0 cmH2O and automatic tube compensation 100% in one period and pressure support 7 cmH2O without automatic tube compensation in the other period, a 4 cmH2O positive end-expiratory pressure being applied in each. Same ventilator brand (Evita XL, Draeger, Germany) was used. Breathing power was assessed from Campbell diagram with esophageal pressure, airway pressure, flow and volume recorded by a data logger. Lung ventilation distribution was assessed by using electrical impedance tomography (Pulmovista, Draeger, Germany). During the last 2 min of low-pressure support and automatic compensation period Breathing power and lung ventilation distribution were measured on each breath. Breathing power generated by the patient’s respiratory muscles was 7.2 (4.4–9.6) and 9.7 (5.7–21.9) J/min in low-pressure support and automatic tube compensation periods, respectively (P = 0.011). Lung ventilation distribution was not different between the two methods. We found that ATC was associated with higher Breathing power than low PS during SBT without altering the distribution of lung ventilation.
A. Esteban - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for extubation failure in patients following a successful Spontaneous Breathing Trial. Commentary
Chest, 2006Co-Authors: Neil Maclntyre, A. Esteban, Fernando Frutos-vivar, Niall D. Ferguson, Scott K. Epstein, Yaseen M. Arabi, Carlos Apezteguia, Marco González, Nicholas S. Hill, Stefano NavaAbstract:Background: To assess the factors associated with reintubation in patients who had successfully passed a Spontaneous Breathing Trial. Methods: We used logistic regression and recursive partitioning analyses of prospectively collected clinical data from adults admitted to ICUs of 37 hospitals in eight countries, who had undergone invasive mechanical ventilation for > 48 h and were deemed ready for extubation. Results: Extubation failure occurred in 121 of the 900 patients (13.4%). The logistic regression analysis identified the following associations with reintubation: rapid shallow Breathing index (RSBI) [odds ratio (OR), 1.009 per unit; 95% confidence interval (CI), 1.003 to 1.015]; positive fluid balance (OR, 1.70; 95% CI, 1.15 to 2.53); and pneumonia as the reason for initiating mechanical ventilation (OR, 1.77; 95% CI, 1.10 to 2.84). The recursive partitioning analysis allowed the separation of patients into different risk groups for extubation failure: (1) RSBI of > 57 breaths/L/min and positive fluid balance (OR, 3.0; 95% CI, 1.8 to 4.8); (2) RSBI of 57 breaths/L/min and negative fluid balance (OR, 1.4; 95% CI, 0.8 to 2.5); and (4) RSBI of < 57 breaths/L/min (OR, 1 [reference value]). Conclusions: Among routinely measured clinical variables, RSBI, positive fluid balance 24 h prior to extubation, and pneumonia at the initiation of ventilation were the best predictors of extubation failure. However, the combined predictive ability of these variables was weak.
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Risk Factors for Extubation Failure in Patients Following a Successful Spontaneous Breathing Trial
Chest, 2006Co-Authors: Fernando Frutos-vivar, A. Esteban, Niall D. Ferguson, Scott K. Epstein, Yaseen M. Arabi, Carlos Apezteguia, Marco González, Nicholas S. Hill, Stefano Nava, Gabriel D'empaireAbstract:Background To assess the factors associated with reintubation in patients who had successfully passed a Spontaneous Breathing Trial. Methods We used logistic regression and recursive partitioning analyses of prospectively collected clinical data from adults admitted to ICUs of 37 hospitals in eight countries, who had undergone invasive mechanical ventilation for > 48 h and were deemed ready for extubation. Results Extubation failure occurred in 121 of the 900 patients (13.4%). The logistic regression analysis identified the following associations with reintubation: rapid shallow Breathing index (RSBI) [odds ratio (OR), 1.009 per unit; 95% confidence interval (CI), 1.003 to 1.015]; positive fluid balance (OR, 1.70; 95% CI, 1.15 to 2.53); and pneumonia as the reason for initiating mechanical ventilation (OR, 1.77; 95% CI, 1.10 to 2.84). The recursive partitioning analysis allowed the separation of patients into different risk groups for extubation failure: (1) RSBI of > 57 breaths/L/min and positive fluid balance (OR, 3.0; 95% CI, 1.8 to 4.8); (2) RSBI of 57 breaths/L/min and negative fluid balance (OR, 1.4; 95% CI, 0.8 to 2.5); and (4) RSBI of Conclusions Among routinely measured clinical variables, RSBI, positive fluid balance 24 h prior to extubation, and pneumonia at the initiation of ventilation were the best predictors of extubation failure. However, the combined predictive ability of these variables was weak.
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effect of Spontaneous Breathing Trial duration on outcome of attempts to discontinue mechanical ventilation
American Journal of Respiratory and Critical Care Medicine, 1999Co-Authors: A. Esteban, Lluis Blanch, F. Gordo, I. Alia, Martin J Tobin, I Vallverdu, A Bonet, A Vazquez, R De Pablo, Antoni TorresAbstract:The duration of Spontaneous Breathing Trials before extubation has been set at 2 h in research studies, but the optimal duration is not known. We conducted a prospective, multicenter study involving 526 ventilator-supported patients considered ready for weaning, to compare clinical outcomes for Trials of Spontaneous Breathing with target durations of 30 and 120 min. Of the 270 and 256 patients in the 30- and 120-min Trial groups, respectively, 237 (87.8%) and 216 (84.8%), respectively, completed the Trial without distress and were extubated (p = 0.32); 32 (13.5%) and 29 (13.4%), respectively, of these patients required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after a Spontaneous Breathing Trial did not differ in the 30- and 120-min Trial groups (75.9% versus 73.0%, respectively, p = 0.43). The 30- and 120-min Trial groups had similar within-unit mortality rates (13 and 9%, respectively) and in-hospital mortality rates (19 and 18%, respectively). Reintubation was required in 61 (13.5%) patients, and these patients had a higher mortality (20 of 61, 32.8%) than did patients who tolerated extubation (18 of 392, 4.6%) (p < 0.001). Neither measurements of respiratory frequency, heart rate, systolic blood pressure, and oxygen saturation during the Trial, nor other functional measurements before the Trial discriminated between patients who required reintubation from those who tolerated extubation. In conclusion, after a first Trial of Spontaneous Breathing, successful extubation was achieved equally effectively with Trials targeted to last 30 and 120 min.
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Spontaneous Breathing Trial with T-Tube
Anaesthesia Pain Intensive Care and Emergency Medicine - A.P.I.C.E., 1998Co-Authors: F. Gordo, I. Alia, A. EstebanAbstract:Discontinuation of mechanical ventilation involves not only the ability to sustain Spontaneous Breathing but also the ability to protect the airway after extubation. The definition of successful weaning is fairly straightforward: most clinicians agree that a patient has been successfully weaned when he remains extubated within 24 to 72 hours after discontinuation of ventilatory support [1-3]. However, weaning failure may be provoked by two different causes: either the necessity of reintubation or the inability to tolerate a Spontaneous Breathing Trial.
Christopher R. Newey - One of the best experts on this subject based on the ideXlab platform.
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Extubating the Neurocritical Care Patient: A Spontaneous Breathing Trial Algorithmic Approach
Neurocritical Care, 2018Co-Authors: Naresh Mullaguri, Zalan Khan, Premkumar Nattanmai, Christopher R. NeweyAbstract:Background Delaying extubation in neurologically impaired patients otherwise ready for extubation is a source for significant morbidity, mortality, and costs. There is no consensus to suggest one Spontaneous Breathing Trial (SBT) over another in predicting extubation success. We studied an algorithm using zero pressure support and zero positive end-expiratory pressure (ZEEP) SBT followed by 5-cm H_2O pressure support and 5-cm H_2O positive end-expiratory pressure (i.e., 5/5) SBT in those who failed ZEEP SBT. Methods This is a retrospective analysis of intubated patients in a neurosciences intensive care unit. All eligible patients were initially challenged with ZEEP SBT. If failed, a 5/5 SBT was immediately performed. If passed either the ZEEP SBT or the subsequent 5/5 SBT, patients were liberated from mechanical ventilation. Results In total, 108 adult patients were included. The majority of patients were successfully liberated from mechanical ventilation using ZEEP SBT alone (82.4%; p = 0.0007). Fifteen (13.8%) patients failed ZEEP SBT but immediately passed 5/5 SBT ( p = 0.0005). One patient (0.93%) required reintubation. We found high sensitivity of this extubation algorithm (100; 95% CI 95.94–100%) but poor specificity (6.67; 95% CI 0.17–31.95%). Conclusion This study showed that the majority of patients could be successfully liberated from mechanical ventilation after a ZEEP SBT. In those who failed, a 5/5 SBT increased the successful liberation from mechanical ventilation.
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Extubating the Neurocritical Care Patient: A Spontaneous Breathing Trial Algorithmic Approach.
Neurocritical care, 2017Co-Authors: Naresh Mullaguri, Zalan Khan, Premkumar Nattanmai, Christopher R. NeweyAbstract:Background Delaying extubation in neurologically impaired patients otherwise ready for extubation is a source for significant morbidity, mortality, and costs. There is no consensus to suggest one Spontaneous Breathing Trial (SBT) over another in predicting extubation success. We studied an algorithm using zero pressure support and zero positive end-expiratory pressure (ZEEP) SBT followed by 5-cm H2O pressure support and 5-cm H2O positive end-expiratory pressure (i.e., 5/5) SBT in those who failed ZEEP SBT.
Kaweesak Chittawatanarat - One of the best experts on this subject based on the ideXlab platform.
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Spontaneous Breathing Trial with Low Pressure Support Protocol for Weaning Respirator in Surgical ICU
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009Co-Authors: Kaweesak Chittawatanarat, Chaweewan ThongchaiAbstract:Objective: Compare the effectiveness between Spontaneous Breathing Trial with low-pressure support protocol and liberal or non-protocol directed method. Material and Method: The authors conducted a retrospective study involving 577 patients who were arranged and appropriate to weaning from mechanical ventilation on general surgical intensive care unit between July 1, 2004 to June 30, 2007. Two hundred and twenty two patients were weaned by their host surgeons or team (liberal group). Three hundred and fifty five patients underwent once daily Spontaneous Breathing Trial with low-pressure support protocol. Patients assigned to this protocol had the pressure support level decreased to 5-7 cm of water for up to two hours each day. If signs of intolerance occurred, the process was restrained while patients who tolerated the two-hour Trial without signs of distress were extubated. The authors collected demographic data, cause of ICU admission, APACHE II score at arranged time to weaning, weaning process time, ventilator day, and ICU length of stay. Results: There was statistical difference between liberal and protocol in age (59.2 + 19.3 vs. 55.6 + 19.8; p = 0.03) but there was no statistical difference in gender (male 74.3 vs. 67.9%; p = 0.2) and APACHE II score at arranged time to wean (14.7 + 7.4 vs. 15.3 + 6.3; p = 0.2). The median (inter-quartile) range duration of weaning process (29.5 (48) vs. 2.25 (2.9), p < 0.001), ventilator day (3 (4) vs. 2 (3), p < 0.001), and length of ICU stay (5 (5) vs. 3 (3), p < 0.001) were shorter in the protocol group than the liberal group. Multivariate linear regression model also revealed significantly less duration of weaning process in the protocol group than the liberal group in terms of weaning time (-63.6 (-74.7 to -2.6) hours), ventilator day (-3.0 (-3.7 to -2.2) days), and length of ICU stay (-2.9 days (-3.7 to -2.0); p < 0.001) (95% confidence interval). Conclusion: Spontaneous Breathing Trial with low-pressure support protocol for liberal from mechanical ventilator was effective to reduce weaning time, ventilator day, and length of ICU stay in general surgical intensive care units. Keywords: Intensive care units, Length of stay, Respiration, Artificial, Respiratory mechanics, Time factors, Ventilator weaning
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Effectiveness of a Spontaneous Breathing Trial with a low-pressure support protocol for liberation from the mechanical ventilator in a general surgical ICU.
Critical Care, 2008Co-Authors: Kaweesak ChittawatanaratAbstract:Discontinuing patients from mechanical ventilation is an important problem in ICUs. The aim of this study is to compare the effectiveness between a Spontaneous Breathing Trial with a low-pressure support protocol and a liberal or nonprotocol-directed method.
Claude Guerin - One of the best experts on this subject based on the ideXlab platform.
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Low-pressure support vs automatic tube compensation during Spontaneous Breathing Trial for weaning
Annals of Intensive Care, 2019Co-Authors: Claude Guerin, Nicolas Terzi, Mehdi Mezidi, Loredana Baboi, Hodane Yonis, Nader Chebib, Laurent Argaud, Leo M. A. Heunks, Bruno LouisAbstract:Background During Spontaneous Breathing Trial, low-pressure support is thought to compensate for endotracheal tube resistance, but it actually should provide overassistance. Automatic tube compensation is an option available in the ventilator to compensate for flow-resistance of endotracheal tube. Its effects on patient effort have been poorly investigated. We aimed to compare the effects of low-pressure support and automatic tube compensation during Spontaneous Breathing Trial on Breathing power and lung ventilation distribution. Results We performed a randomized crossover study in 20 patients ready to wean. Each patient received both methods for 30 min separated by baseline ventilation: pressure support 0 cmH_2O and automatic tube compensation 100% in one period and pressure support 7 cmH_2O without automatic tube compensation in the other period, a 4 cmH_2O positive end-expiratory pressure being applied in each. Same ventilator brand (Evita XL, Draeger, Germany) was used. Breathing power was assessed from Campbell diagram with esophageal pressure, airway pressure, flow and volume recorded by a data logger. Lung ventilation distribution was assessed by using electrical impedance tomography (Pulmovista, Draeger, Germany). During the last 2 min of low-pressure support and automatic compensation period Breathing power and lung ventilation distribution were measured on each breath. Breathing power generated by the patient’s respiratory muscles was 7.2 (4.4–9.6) and 9.7 (5.7–21.9) J/min in low-pressure support and automatic tube compensation periods, respectively ( P = 0.011). Lung ventilation distribution was not different between the two methods. Conclusions We found that ATC was associated with higher Breathing power than low PS during SBT without altering the distribution of lung ventilation.
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Low-pressure support vs automatic tube compensation during Spontaneous Breathing Trial for weaning.
Annals of intensive care, 2019Co-Authors: Claude Guerin, Nicolas Terzi, Mehdi Mezidi, Loredana Baboi, Hodane Yonis, Nader Chebib, Laurent Argaud, Leo M. A. Heunks, Bruno LouisAbstract:During Spontaneous Breathing Trial, low-pressure support is thought to compensate for endotracheal tube resistance, but it actually should provide overassistance. Automatic tube compensation is an option available in the ventilator to compensate for flow-resistance of endotracheal tube. Its effects on patient effort have been poorly investigated. We aimed to compare the effects of low-pressure support and automatic tube compensation during Spontaneous Breathing Trial on Breathing power and lung ventilation distribution. We performed a randomized crossover study in 20 patients ready to wean. Each patient received both methods for 30 min separated by baseline ventilation: pressure support 0 cmH2O and automatic tube compensation 100% in one period and pressure support 7 cmH2O without automatic tube compensation in the other period, a 4 cmH2O positive end-expiratory pressure being applied in each. Same ventilator brand (Evita XL, Draeger, Germany) was used. Breathing power was assessed from Campbell diagram with esophageal pressure, airway pressure, flow and volume recorded by a data logger. Lung ventilation distribution was assessed by using electrical impedance tomography (Pulmovista, Draeger, Germany). During the last 2 min of low-pressure support and automatic compensation period Breathing power and lung ventilation distribution were measured on each breath. Breathing power generated by the patient’s respiratory muscles was 7.2 (4.4–9.6) and 9.7 (5.7–21.9) J/min in low-pressure support and automatic tube compensation periods, respectively (P = 0.011). Lung ventilation distribution was not different between the two methods. We found that ATC was associated with higher Breathing power than low PS during SBT without altering the distribution of lung ventilation.
