Extubation Outcome after Spontaneous Breathing Trials with T-tube or Pressure Support Ventilation

A 2-h T-tube trial of spontaneous breathing was used in selecting patients ready for extubation and discontinuation of mechanical ventilation. However, some doubt remains as to whether it is the most appropriate method of performing a spontaneous breathing trial. We carried out a prospective, randomized, study involving patients who had received mechanical ventilation for more than 48 h and who were considered by their physicians to be ready for weaning according to clinical criteria and standard weaning parameters. Patients were randomly assigned to undergo a 2-h trial of spontaneous breathing in one of two ways: with a T-tube system or with pressure support ventilation of 7 cm H2O. If a patient had signs of poor tolerance at any time during the trial, mechanical ventilation was reinstituted. Patients without these features at the end of the trial were extubated. Of the 20 patients assigned to the T-tube group, 15 successfully completed the trial and were extubated; 5 of them required reintubation. Of the 20 patients in the group receiving pressure support venti¬lation, 17 were extubated and 3 of them required reintubation. The percentage of patients failing the trial and ICU mortality was significantly higher when the T-tube was used. Clinical evolution during the trial was not different in patients reintubated and successfully extubated. Spontaneous breathing trials with pressure support or T-tube are suitable methods for successful dis¬continuation of ventilator support in patients without problems to resume spontaneous breathing.