Flora Delamaire, Adel Maamar, Pauline Guillot, Quentin Quelven, Valentin Coirier, Benoit Painvin, Jean-Marc Tadie, Nicolas Terzi, Arnaud Gacouin
Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, F-35033, France.
Université de Rennes 1, Faculté de Médecine, Rennes, F-35043, France.
Ann Intensive Care. 2025 Apr 1;15(1):47. doi: 10.1186/s13613-025-01455-x.
In critically ill patients, weaning from mechanical ventilation (MV) includes spontaneous breathing trial (SBT) usually followed by a reventilation period in order to recover from the alveolar derecruitement induced by the SBT. The measurement of occlusion pressure during the first 100 ms of an airway occlusion (P) one of the non-invasive tools available for estimating the respiratory drive, is a determinant of patient respiratory effort. This clinical study explores the use of non-invasive continuous monitoring of occlusion pressure automatically calculated by ventilators in the first 100 ms of airway occlusion (P vent) during SBT and reventilation periods. The study aimed to investigate patient or respirator factors influencing P as well as the association of P values with extubation success or failure.
This prospective observational study, conducted from February 2022 to April 2023, included adult patients intubated for more than 24 h and screened for extubation weaning. SBTs were performed for one hour with zero pressure support and zero end-expiratory pressure (PS0 ZEEP). Reventilation followed for an hour with pressure support (8-12 cmHO) and PEEP (5 cmHO). Data included patient characteristics, ventilator parameters and extubation outcomes.
The study involved 224 measurements from 212 patients, with 157 successful extubations, 46 extubation failures at day 7 and 21 SBT failures. P mean values were significantly higher for extubation failures and SBT failures compared to successful extubations (p < 0.001). Delta P ((P reventilation - P SBT)/ P SBT) was significantly different according to whether extubation was a success or a failure: 0.21 (0.02-0.62) cm HO vs. P vs. 1.12 (0.54-2.38) cm HO; p < 0.0001 respectively. Values significantly differed in both the SBT and the reventilation periods whether or not patients had previous ARDS: 1.08 (0.70; 2.02) cmHO vs. 0.80 (0.54; 1.28) cmHO respectively (p = 0.003). Noteworthy, P values were influenced by airway humidification systems (0.92 (0.57; 1.54) cmHO with humidification vs. 1.27 (0.91; 2.24) cmHO without, p = 0.003).
The delta of Pvent values between SBT and reventilation are higher for patients who fail extubation, especially for those who had ARDS. While elevated P values were associated with extubation failure, the overlap in values limits its usefulness as a reliable predictor.
在重症患者中，机械通气（MV）撤机包括自主呼吸试验（SBT），通常随后会有一个再通气期，以便从SBT引起的肺泡萎陷中恢复。气道闭塞最初100毫秒时的闭塞压（P）测量是可用于评估呼吸驱动力的非侵入性工具之一，是患者呼吸努力的一个决定因素。这项临床研究探讨了在SBT和再通气期间，通过呼吸机自动计算气道闭塞最初100毫秒时的闭塞压（Pvent）进行非侵入性连续监测的应用。该研究旨在调查影响P的患者或呼吸机因素，以及P值与拔管成功或失败的关联。
这项前瞻性观察性研究于2022年2月至2023年4月进行，纳入了插管超过24小时并接受拔管撤机筛查的成年患者。SBT在零压力支持和零呼气末正压（PS0 ZEEP）下进行1小时。随后进行1小时的再通气，采用压力支持（8 - 12 cmH₂O）和呼气末正压（5 cmH₂O）。数据包括患者特征、呼吸机参数和拔管结果。
该研究涉及212例患者的224次测量，其中157例拔管成功，7天时有46例拔管失败，21例SBT失败。与拔管成功相比，拔管失败和SBT失败时的P平均值显著更高（p < 0.001）。根据拔管是否成功，P的变化量（（再通气时的P - SBT时的P）/ SBT时的P）显著不同：0.21（0.02 - 0.62）cmH₂O 与 P 相比 1.12（0.54 - 2.38）cmH₂O；p < 0.0001。无论患者之前是否患有急性呼吸窘迫综合征（ARDS），在SBT和再通气期间的值均有显著差异：分别为1.08（0.70；2.02）cmH₂O 与 0.80（0.54；1.28）cmH₂O（p = 0.003）。值得注意的是，P值受气道加湿系统影响（有加湿时为0.92（0.57；1.54）cmH₂O，无加湿时为1.27（0.91；2.24）cmH₂O，p = 0.003）。
对于拔管失败的患者，尤其是那些患有ARDS的患者，SBT和再通气之间Pvent值的变化量更高。虽然P值升高与拔管失败相关，但值的重叠限制了其作为可靠预测指标的实用性。
