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

• Published in: Journal of critical care Vol. 67; pp. 95 - 99
• Main Authors: Gacouin, Arnaud, Lesouhaitier, Mathieu, Reizine, Florian, Painvin, Benoit, Maamar, Adel, Camus, Christophe, Le Tulzo, Yves, Tadié, Jean Marc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022; Elsevier Limited; WB Saunders
• Subjects: Airway Extubation - methods; Blood pressure; Cohort analysis; Cohort study; Critical care; Extubation; Extubation outcome; Humans; Hypotheses; Intubation; Intubation, Intratracheal - methods; Life Sciences; Mechanical ventilation; Patients; Positive-Pressure Respiration; Pressure support ventilation; Respiration, Artificial - methods; Spontaneous breathing trial; Survival analysis; Variance analysis; Ventilation; Ventilator weaning; Ventilator Weaning - methods; Ventilators; Weaning; Pressure support ventilation; Ventilator weaning; Extubation outcome; Mechanical ventilation; Cohort study; Spontaneous breathing trial
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2021.10.016

Physiological data suggest that T-piece and zero pressure support (PS0) ventilation both accurately reflect spontaneous breathing conditions after extubation. These two types of spontaneous breathing trials (SBTs) are used in our Intensive Care Unit to evaluate patients for extubation readiness and success but have rarely been compared in clinical studies. We performed a prospective observational study to confirm the hypothesis that 1-hour T-piece SBT and 1-h PS0 zero PEEP (ZEEP) SBT are associated with similar rates of reintubation at day 7 after extubation. A non-inferiority approach was used for sample size calculation. The cohort consisted of 529 subjects invasively ventilated for more than 24 h and extubated after successful 1-hour T-piece SBT (n = 303, 57%) or 1-h PS0 ZEEP SBT (n = 226, 43%). The reintubation rate at day 7 was 14.6% with PS0 ZEEP and 17.5% with T-piece (difference − 2.6% [95% confidence interval, −8.3% to 4.3%]; p = 0.40). The reasons for reintubation did not differ significantly when compared between patients with 1-h PS0 ZEEP SBT and patients with 1-hour T-piece SBT. Our results suggest that successful 1-hour T-piece and 1-h PSO ZEEP SBTs are associated with similar reintubation rates at day 7. •It remains uncertain that T-piece and zero PS spontaneous breathing trials led to similar rates of successful extubation.•No patient disconnection from the ventilator can facilitate monitoring, and could prevent aerosols of pathogens. Patients with successful 1-hour T-Piece and 1-hour zero PS ventilation 0 PEEP SBT trials were assessed for reintubation.•One-hour T-piece SBT and 1-hour zero PS ventilation ZEEP SBT were associated with similar reintubation rates at day 7. It remains uncertain that T-piece and zero pressure support spontaneous breathing trials (SBT) led to similar rates of successful extubation.•No patient disconnection from the ventilator can facilitate monitoring, may reduce the burden of care, and could prevent aerosols of pathogens.•Patients with successful 1-hour T-Piece SBT and 1-hour zero PS ventilation zero PEEP SBT trial were assessed for reintubation at day 7.•One-hour T-piece SBT and 1-hour zero PS ventilation ZEEP were associated with similar reintubation rates at day 7.