压力支持通气与 T 型管在拔管失败高危患者自主呼吸试验中的比较：一项临床试验的事后分析。

Pressure-Support Ventilation vs T-Piece During Spontaneous Breathing Trials Before Extubation Among Patients at High Risk of Extubation Failure: A Post-Hoc Analysis of a Clinical Trial.

机构信息

Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France; INSERM Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France.

出版信息

Chest. 2020 Oct;158(4):1446-1455. doi: 10.1016/j.chest.2020.04.053. Epub 2020 May 19.

DOI:10.1016/j.chest.2020.04.053

PMID:32439503

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 HO 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.

摘要

背景

在 ICU 中，使用 T 型管进行自主呼吸试验（SBT）仍然是最常进行的拔管前试验。

研究问题

我们旨在确定在有拔管失败高风险的患者中，最初使用压力支持通气（PSV）的 SBT 是否可以提高成功拔管的比例。

研究设计和方法

对一项专注于有拔管失败高风险患者再插管的多中心试验进行事后分析。最初的 SBT 根据医生/中心的决定使用 PSV 或 T 型管进行。主要结局是最初 SBT 后 72 小时成功拔管的患者比例，即在最初的 SBT 后拔管且在随后的 72 小时内没有再插管的患者比例。

结果

在原始研究中纳入的 641 名患者中，243 名（38%）患者最初使用 PSV（中位数为 7.0cmH2O，没有呼气末正压）进行 SBT，398 名（62%）患者使用 T 型管进行 SBT。最初的 SBT 后 72 小时成功拔管的患者比例分别为使用 PSV 的 67%（162/243）和使用 T 型管的 56%（223/398）（绝对差异为 10.6%；95%CI，2.8 至 28.1；P=0.0076）。最初的 SBT 后拔管的患者比例分别为使用 PSV 的 77%（186/283）和使用 T 型管的 63%（249/398）（P=0.0002），而随后的 72 小时内的再插管率无显著差异（分别为 13%和 10%；P=0.4259）。最初使用 PSV 进行 SBT 与成功拔管独立相关（调整后的 OR，1.60；95%CI，1.30 至 2.18；P=0.0061）。