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Pressure-Support Ventilation vs T-Piece During Spontaneous Breathing Trials Before Extubation Among Patients at High Risk of Extubation Failure

Arnaud W. Thille 1 Rémi Coudroy 1 Mai-Anh Nay 2 Arnaud Gacouin 3 Alexandre Demoule 4 Romain Sonneville 5 François Beloncle 6 Christophe Girault 7 Laurence Dangers 8 Alexandre Lautrette 9 Quentin Levrat Anahita Rouze 10 Emmanuel Vivier 11 Jean-Baptiste Lascarrou 12 Jean-Damien Ricard 13 Keyvan Razazi 14 Guillaume Barberet 15 Christine Lebert 16 Stephan Ehrmann 17 Alexandre Massri 18 Jeremy Bourenne 19 Gael Pradel 20 Pierre Bailly 21 Nicolas Terzi 22 Jean Dellamonica 23 Guillaume Lacave 24 René Robert 1 Stéphanie Ragot 1 Jean-Pierre Frat 1 Florence Boissier Delphine Chatellier Céline Deletage Carole Guignon Florent Joly Morgane Olivry Anne Veinstein Dalila Benzekri-Lefevre Thierry Boulain Grégoire Muller Yves Le Tulzo Jean-Marc Tadié Adel Maamar Suela Demiri Julien Mayaux Maxens Decavèle Lila Bouadma Claire Dupuis Pierre Asfar Marc Pierrot Gaëtan Béduneau Déborah Boyer Benjamin Delmas Bérénice Puech Konstantinos Bachoumas Edouard Soum Séverin Cabasson Marie-Anne Hoppe Saad Nseir 10, 25 Olivier Pouly Gaël Bourdin Sylvène Rosselli Anthony Le Meur Charlotte Garret Maelle Martin Guillaume Berquier Abirami Thiagarajah Guillaume Carteaux Armand Mekontso-Dessap Antoine Poidevin Anne-Florence Dureau Marie-Ange Azais Gwenhaël Colin Emmanuelle Mercier Marlène Morisseau Caroline Sabatier Walter Picard Marc Gainnier Thi-My-Hue Nguyen Gwenaël Prat Carole Schwebel Matthieu Buscot
Abstract : Background Spontaneous breathing trial (SBT) using a T-piece remains the most frequently performed trial before extubation in ICUs. Research Question We aimed at determining whether initial SBT using pressure-support ventilation (PSV) could increase successful extubation rates among patients at high risk of extubation failure. Study Design and Methods Post hoc analysis of a multicenter trial focusing on reintubation in patients at high-risk of extubation failure. The initial SBT was performed using PSV or T-piece according to the physician/center decision. The primary outcome was the proportion of patients successfully extubated 72 hours after initial SBT, that is, extubated after initial SBT and not reintubated within the following 72 hours. Results Among the 641 patients included in the original study, initial SBT was performed using PSV (7.0 cm H2O in median without positive end-expiratory pressure) in 243 patients (38%) and using a T-piece in 398 patients (62%). The proportion of patients successfully extubated 72 hours after initial SBT was 67% (162/243) using PSV and 56% (223/398) using T-piece (absolute difference 10.6%; 95% CI, 2.8 to 28.1; P = .0076). The proportion of patients extubated after initial SBT was 77% (186/283) using PSV and 63% (249/398) using T-piece (P = .0002), whereas reintubation rates within the following 72 hours did not significantly differ (13% vs 10%, respectively; P = .4259). Performing an initial SBT using PSV was independently associated with successful extubation (adjusted OR, 1.60; 95% CI, 1.30 to 2.18; P = .0061). Interpretation In patients at high risk of extubation failure in the ICU, performing an initial SBT using PSV may hasten extubation without an increased risk of reintubation.
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https://hal.univ-lille.fr/hal-03325552
Contributeur : Lilloa Université de Lille <>
Soumis le : mercredi 25 août 2021 - 08:59:32
Dernière modification le : vendredi 27 août 2021 - 03:16:32

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Arnaud W. Thille, Rémi Coudroy, Mai-Anh Nay, Arnaud Gacouin, Alexandre Demoule, et al.. Pressure-Support Ventilation vs T-Piece During Spontaneous Breathing Trials Before Extubation Among Patients at High Risk of Extubation Failure. Chest, American College of Chest Physicians, 2020, Chest, 158 (4), pp.1446-1455. ⟨10.1016/j.chest.2020.04.053⟩. ⟨hal-03325552⟩

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