Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
Med Intensiva (Engl Ed). 2024 Sep;48(9):501-510. doi: 10.1016/j.medine.2023.07.010. Epub 2023 Oct 3.
To assess the changes in lung aeration and respiratory effort generated by two different spontaneous breathing trial (SBT): T-piece (T-T) vs pressure support ventilation (PSV).
Prospective, interventionist and randomized study.
Intensive Care Unit (ICU) of Hospital del Mar.
Forty-three ventilated patients for at least 24 h and considered eligible for an SBT were included in the study between October 2017 and March 2020.
30-min SBT with T-piece (T-T group, 20 patients) or 8-cmHO PSV and 5-cmHO positive end expiratory pressure (PSV group, 23 patients).
Demographics, clinical data, physiological variables, lung aeration evaluated with electrical impedance tomography (EIT) and lung ultrasound (LUS), and respiratory effort using diaphragmatic ultrasonography (DU) were collected at different timepoints: basal (BSL), end of SBT (EoSBT) and one hour after extubation (OTE).
There were a loss of aeration measured with EIT and LUS in the different study timepoints, without statistical differences from BSL to OTE, between T-T and PSV [LUS: 3 (1, 5.5) AU vs 2 (1, 3) AU; p = 0.088; EELI: -2516.41 (-5871.88, 1090.46) AU vs -1992.4 (-3458.76, -5.07) AU; p = 0.918]. Percentage of variation between BSL and OTE, was greater when LUS was used compared to EIT (68.1% vs 4.9%, p ≤ 0.001). Diaphragmatic excursion trend to decrease coinciding with a loss of aeration during extubation.
T-T and PSV as different SBT strategies in ventilated patients do not show differences in aeration loss, nor estimated respiratory effort or tidal volume measured by EIT, LUS and DU.
评估两种不同自主呼吸试验（SBT）：T 型管（T-T）与压力支持通气（PSV）引起的肺通气和呼吸努力的变化。
前瞻性、干预性和随机研究。
巴塞罗那医院的重症监护病房（ICU）。
2017 年 10 月至 2020 年 3 月期间，纳入了至少接受 24 小时通气且符合 SBT 条件的 43 名患者。
30 分钟 T 型管（T-T 组，20 名患者）或 8cmH2O PSV 和 5cmH2O 呼气末正压（PSV 组，23 名患者）的 SBT。
人口统计学、临床数据、生理变量、使用电阻抗断层成像（EIT）和肺部超声（LUS）评估的肺通气、以及使用膈肌超声（DU）评估的呼吸努力，在不同时间点（基础状态（BSL）、SBT 结束时（EoSBT）和拔管后 1 小时（OTE））采集。
EIT 和 LUS 测量的通气在不同的研究时间点均有丧失，但从 BSL 到 OTE 无统计学差异，T-T 和 PSV 之间无差异[LUS：3（1，5.5）AU 与 2（1，3）AU；p=0.088；EELI：-2516.41（-5871.88，1090.46）AU 与-1992.4（-3458.76，-5.07）AU；p=0.918]。与 EIT 相比，使用 LUS 时 BSL 和 OTE 之间的变化百分比更大（68.1%比 4.9%，p≤0.001）。膈肌运动趋势下降，与拔管期间通气丧失一致。
在通气患者中，T-T 和 PSV 作为两种不同的 SBT 策略，在通气丧失、通过 EIT、LUS 和 DU 测量的估计呼吸努力或潮气量方面均无差异。
