scholarly journals 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 ◽  
2008 ◽  
Vol 12 (Suppl 2) ◽  
pp. P327
Author(s):  
K Chittawatanarat
Keyword(s):  
Spontaneous Breathing ◽  
Pressure Support ◽  
Spontaneous Breathing Trial ◽  
Low Pressure ◽  
Mechanical Ventilator ◽  
Surgical Icu

scholarly journals Low-pressure support vs automatic tube compensation during spontaneous breathing trial for weaning

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Claude Guérin ◽  
Nicolas Terzi ◽  
Mehdi Mezidi ◽  
Loredana Baboi ◽  
Nader Chebib ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Spontaneous Breathing ◽  
Pressure Support ◽  
Spontaneous Breathing Trial ◽  
Lung Ventilation ◽  
Low Pressure ◽  
Ventilation Distribution ◽  
Data Logger ◽  
Impedance Tomography ◽  
Tube Compensation

Abstract 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 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. Conclusions We found that ATC was associated with higher breathing power than low PS during SBT without altering the distribution of lung ventilation.

Spontaneous breathing trial in T-tube negatively impact on autonomic modulation of heart rate compared with pressure support in critically ill patients

2015 ◽  
Vol 11 (4) ◽  
pp. 489-495 ◽  
Author(s):  
Adriana M. Güntzel Chiappa ◽  
Gaspar R. Chiappa ◽  
Gerson Cipriano ◽  
Ruy S. Moraes ◽  
Elton L Ferlin ◽  
...  
Keyword(s):  
Heart Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Spontaneous Breathing ◽  
Pressure Support ◽  
Spontaneous Breathing Trial ◽  
Autonomic Modulation ◽  
T Tube

Accuracy of a spontaneous breathing trial for extubation of neonates

2020 ◽  
pp. 1-8
Author(s):  
M. Fiatt ◽  
A.C. Bosio ◽  
D. Neves ◽  
R. Symanski da Cunha ◽  
L.T. Fonseca ◽  
...  
Keyword(s):  
Predictive Value ◽  
Spontaneous Breathing ◽  
Pressure Support ◽  
Spontaneous Breathing Trial ◽  
Invasive Mechanical Ventilation ◽  
Newborn Infants ◽  
Extubation Failure ◽  
Great Accuracy ◽  
Minimum Pressure ◽  
Persistent Arterial Duct

BACKGROUND: Prevalence of extubation failure in neonates may be up to 80%, but evidence to determine if a neonate is ready for extubation remains unclear. We aim to evaluate a spontaneous breathing trial accuracy with minimum pressure support to predict success in neonates’ extubation and identify variables related to failures. METHODS: This is a diagnostic accuracy study based on a cohort study in an intensive care unit with all eligible newborn infants subjected to invasive mechanical ventilation for at least 24 hours submitted to the trial for 10 minutes before extubations. The outcome was failures of extubations, considered if reintubation was needed until 72 hours. RESULTS: The incidence of failure was 14.7%among 170 extubations. There were 145 successful extubations; of these, 140 also passed the trial with a sensitivity of 96.5%(95%CI: 92.1–98.9). Of the 25 extubations that eventually failed, 16 failed the test with a specificity of 64.0%(95%CI: 42.5–82.0). The negative predictive value was 76.2%, and the positive predictive value was 94%. In stratifying by weight, the accuracy was >98.7%for neonates weighting >2500 g, but 72.5%for those weighing <1250 g. Extubation failures occurred more frequently in smaller (p = 0.01), preterm infants (p = 0.17), with longer ventilation time (p = 0.05), and having a hemodynamically significant persistent arterial duct (p = 0.01), compared with infants whose extubation was successful. CONCLUSION: The spontaneous breathing trial with minimum pressure support ventilation seems to predict extubation success with great accuracy in full-term and larger neonates.

A spontaneous breathing trial with pressure support overestimates readiness for extubation in children

2011 ◽  
Vol 12 (6) ◽  
pp. e330-e335 ◽  
Author(s):  
Lee P. Ferguson ◽  
Brian K. Walsh ◽  
Daphne Munhall ◽  
John H. Arnold
Keyword(s):  
Spontaneous Breathing ◽  
Pressure Support ◽  
Spontaneous Breathing Trial

scholarly journals Patient–Ventilator Interaction Testing Using the Electromechanical Lung Simulator xPULM™ during V/A-C and PSV Ventilation Mode

2021 ◽  
Vol 11 (9) ◽  
pp. 3745
Author(s):  
Richard Pasteka ◽  
Joao Pedro Santos da Costa ◽  
Nelson Barros ◽  
Radim Kolar ◽  
Mathias Forjan
Keyword(s):  
Spontaneous Breathing ◽  
Pressure Support ◽  
Peak Inspiratory Pressure ◽  
Mechanical Ventilator ◽  
Lung Simulator ◽  
Alternative Approach ◽  
Interaction Testing ◽  
Flow Pressure ◽  
Triggering Events ◽  
Test Patient

During mechanical ventilation, a disparity between flow, pressure and volume demands of the patient and the assistance delivered by the mechanical ventilator often occurs. This paper introduces an alternative approach of simulating and evaluating patient–ventilator interactions with high fidelity using the electromechanical lung simulator xPULM™. The xPULM™ approximates respiratory activities of a patient during alternating phases of spontaneous breathing and apnea intervals while connected to a mechanical ventilator. Focusing on different triggering events, volume assist-control (V/A-C) and pressure support ventilation (PSV) modes were chosen to test patient–ventilator interactions. In V/A-C mode, a double-triggering was detected every third breathing cycle, leading to an asynchrony index of 16.67%, which is classified as severe. This asynchrony causes a significant increase of peak inspiratory pressure (7.96 ± 6.38 vs. 11.09 ± 0.49 cmH2O, p < 0.01)) and peak expiratory flow (−25.57 ± 8.93 vs. 32.90 ± 0.54 L/min, p < 0.01) when compared to synchronous phases of the breathing simulation. Additionally, events of premature cycling were observed during PSV mode. In this mode, the peak delivered volume during simulated spontaneous breathing phases increased significantly (917.09 ± 45.74 vs. 468.40 ± 31.79 mL, p < 0.01) compared to apnea phases. Various dynamic clinical situations can be approximated using this approach and thereby could help to identify undesired patient–ventilation interactions in the future. Rapidly manufactured ventilator systems could also be tested using this approach.

scholarly journals 1-hour t-piece spontaneous breathing trial vs 1-hour zero pressure support spontaneous breathing trial and reintubation at day 7: A non-inferiority approach

2022 ◽  
Vol 67 ◽  
pp. 95-99
Author(s):  
Arnaud Gacouin ◽  
Mathieu Lesouhaitier ◽  
Florian Reizine ◽  
Benoit Painvin ◽  
Adel Maamar ◽  
...  
Keyword(s):  
Spontaneous Breathing ◽  
Pressure Support ◽  
Spontaneous Breathing Trial

scholarly journals Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation

2020 ◽  
Vol 132 (5) ◽  
pp. 1114-1125 ◽  
Author(s):  
Martin Dres ◽  
Bruno-Pierre Dubé ◽  
Ewan Goligher ◽  
Stefannie Vorona ◽  
Suela Demiri ◽  
...  
Keyword(s):  
Spontaneous Breathing ◽  
Pressure Support ◽  
Spontaneous Breathing Trial ◽  
Intraclass Correlation ◽  
Inverse Correlation ◽  
Clinical Information ◽  
Assisted Ventilation ◽  
Intercostal Muscle ◽  
Diaphragm Dysfunction ◽  
Generating Capacity

Abstract Background The assessment of diaphragm function with diaphragm ultrasound seems to bring important clinical information to describe diaphragm work and weakness. When the diaphragm is weak, extradiaphragmatic muscles may play an important role, but whether ultrasound can also assess their activity and function is unknown. This study aimed to (1) evaluate the feasibility of measuring the thickening of the parasternal intercostal and investigate the responsiveness of this muscle to assisted ventilation; and (2) evaluate whether a combined evaluation of the parasternal and the diaphragm could predict failure of a spontaneous breathing trial. Methods First, an exploratory evaluation of the parasternal in 23 healthy subjects. Second, the responsiveness of parasternal to several pressure support levels were studied in 16 patients. Last, parasternal activity was compared in presence or absence of diaphragm dysfunction (assessed by magnetic stimulation of the phrenic nerves and ultrasound) and in case of success/failure of a spontaneous breathing trial in 54 patients. Results The parasternal was easily accessible in all patients. The interobserver reproducibility was good (intraclass correlation coefficient, 0.77 (95% CI, 0.53 to 0.89). There was a progressive decrease in parasternal muscle thickening fraction with increasing levels of pressure support (Spearman ρ = −0.61 [95% CI, −0.74 to −0.44]; P &lt; 0.0001) and an inverse correlation between parasternal muscle thickening fraction and the pressure generating capacity of the diaphragm (Spearman ρ = −0.79 [95% CI, −0.87 to −0.66]; P &lt; 0.0001). The parasternal muscle thickening fraction was higher in patients with diaphragm dysfunction: 17% (10 to 25) versus 5% (3 to 8), P &lt; 0.0001. The pressure generating capacity of the diaphragm, the diaphragm thickening fraction and the parasternal thickening fraction similarly predicted failure or the spontaneous breathing trial. Conclusions Ultrasound assessment of the parasternal intercostal muscle is feasible in the intensive care unit and provides novel information regarding the respiratory capacity load balance. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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