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.

scholarly journals Automatic Tube Compensation versus Pressure Support Ventilation and Extubation Outcome in Children: A Randomized Controlled Study

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Ahmed Saad El-din El-beleidy ◽  
Asser Abd EL-Hamied Khattab ◽  
Seham Awad El-Sherbini ◽  
Hebatalla Fadel Al-gebaly
Keyword(s):  
Risk Factors ◽  
Pressure Support Ventilation ◽  
Predictive Value ◽  
Spontaneous Breathing ◽  
Pressure Support ◽  
Spontaneous Breathing Trial ◽  
Extubation Failure ◽  
Support Ventilation ◽  
Extubation Outcome ◽  
Tube Compensation

Background. Automatic tube compensation (ATC) has been developed to overcome the imposed work of breathing due to artificial airways during spontaneous breathing trials (SBTs). Objectives. This study aimed to assess extubation outcome after an SBT (spontaneous breathing trial) with ATC compared with pressure support ventilation (PSV) and to determine the risk factors for extubation failure. Methods. Patients ready for extubation were randomly assigned to two-hour spontaneous breathing trial with either ATC or pressure support ventilation. Results. In the ATC group (), 11 (65%) patients passed the SBT with subsequent extubation failure (9%). While in PSV group (), 10 (53%) patients passed the SBT with subsequent extubation failure (10%). This represented a positive predictive value for ATC of 91% and PSV of 90% (). Five (83%) of the patients who failed the SBT in ATC group were reintubated. This represented a higher negative predictive value for ATC of 83% than for PSV which was 56%. None of the assessed risk factors were independently associated with extubation failure including failed trial. Conclusion. ATC was equivalent to PSV in predicting patients with successful extubation. A trial failure in ATC group is associated with but does not definitely predict extubation failure.

An Integrative Index for Predicting Extubation Outcomes After Successful Completion of a Spontaneous Breathing Trial in an Adult Medical Intensive Care Unit

2017 ◽  
Vol 34 (8) ◽  
pp. 640-645 ◽  
Author(s):  
Tsung-Ju Wu ◽  
Judith Shu-Chu Shiao ◽  
Hsin-Liang Yu ◽  
Ruay-Sheng Lai
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Serum Albumin ◽  
Spontaneous Breathing ◽  
Characteristic Curve ◽  
Spontaneous Breathing Trial ◽  
Invasive Mechanical Ventilation ◽  
Extubation Failure ◽  
Rapid Shallow Breathing Index ◽  
Medical Intensive Care

Background: Among respiratory predictors, rapid shallow breathing index (RSBI) has been a commonly used respiratory parameter to predict extubation outcomes. However, the outcome of prediction remains inconsistent. Regarding nonrespiratory predictors, serum albumin, hemoglobin, bicarbonate, and patients’ alertness have been reported to be associated with successful weaning or extubation. We aimed to develop an integrative index combining commonly used predictors in the adult medical intensive care units (MICUs) and to compare the predictability of the index with RSBI. Methods: This prospective observational study with retrospective data collection of planned extubations was conducted in a 14-bed adult MICU. We enrolled patients who received mechanical ventilation via an endotracheal tube in the adult MICU for >24 hours and passed a 2-hour spontaneous breathing trial and underwent extubation. Extubation failure was defined as reinstitution of invasive mechanical ventilation within 48 hours of extubation. Respiratory parameters and Glasgow Coma Scale (GCS) scores of patients were recorded prospectively. Nonrespiratory parameters were recorded retrospectively. Logistic regression was used to determine significant predictors of extubation outcomes. Results: Fifty-nine patients comprising 70 extubations were enrolled. Extubation failure was significantly and positively associated with lower serum albumin (albumin < 2.6 g/dL, odds ratio [OR] = 5.1; 95% confidence interval [CI], 1.04-24.66), lower hemoglobin (hemoglobin < 10.0 g/dL, OR = 10.8; 95% CI, 2.00-58.04), and lower GCS scores (GCS score ≤ 8, OR = 6.1; 95% CI = 1.15-32.34). By using an integrative index combining the 3 parameters together, the sensitivity and specificity to predict extubation outcomes were 78.6% and 75.9%, respectively. The area under the receiver operating characteristic curve of the index was significantly higher than RSBI (0.84 vs 0.61, P = .026). Conclusion: The integrative index combining serum albumin, hemoglobin, and GCS scores could predict extubation outcomes better than RSBI in an adult MICU.

scholarly journals T-piece versus pressure-support ventilation for spontaneous breathing trials before extubation in patients at high risk of reintubation: protocol for a multicentre, randomised controlled trial (TIP-EX)

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e042619
Author(s):  
Arnaud W Thille ◽  
Rémi Coudroy ◽  
Arnaud Gacouin ◽  
Stephan Ehrmann ◽  
Damien Contou ◽  
...  
Keyword(s):  
High Risk ◽  
Randomised Controlled Trial ◽  
Pressure Support Ventilation ◽  
Spontaneous Breathing ◽  
Pressure Support ◽  
Controlled Trial ◽  
Invasive Mechanical Ventilation ◽  
Support Ventilation ◽  
Number Of Patients ◽  
Randomised Controlled

IntroductionIn intensive care unit (ICU), the decision of extubation is a critical time because mortality is particularly high in case of reintubation. To reduce that risk, guidelines recommend to systematically perform a spontaneous breathing trial (SBT) before extubation in order to mimic the postextubation physiological conditions. SBT is usually performed with a T-piece disconnecting the patient from the ventilator or with low levels of pressure-support ventilation (PSV). However, work of breathing is lower during PSV than during T-piece. Consequently, while PSV trial may hasten extubation, it may also increase the risk of reintubation. We hypothesise that, compared with T-piece, SBT performed using PSV may hasten extubation without increasing the risk of reintubation.Methods and analysisThis study is an investigator-initiated, multicentre randomised controlled trial comparing T-piece vs PSV for SBTs in patients at high risk of reintubation in ICUs. Nine hundred patients will be randomised with a 1:1 ratio in two groups according to the type of SBT. The primary outcome is the number of ventilator-free days at day 28, defined as the number of days alive and without invasive mechanical ventilation between the initial SBT (day 1) and day 28. Secondary outcomes include the number of days between the initial SBT and the first extubation attempt, weaning difficulty, the number of patients extubated after the initial SBT and not reintubated within the following 72 hours, the number of patients extubated within the 7 days following the initial SBT, the number of patients reintubated within the 7 days following extubation, in-ICU length of stay and mortality in ICU, at day 28 and at day 90.Ethics and disseminationThe study has been approved by the central ethics committee ‘Ile de France V’ (2019-A02151-56) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT04227639.

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

Risk Factors for Extubation Failure in Patients Following a Successful Spontaneous Breathing Trial

CHEST Journal ◽  
2006 ◽  
Vol 130 (6) ◽  
pp. 1664-1671 ◽  
Author(s):  
Fernando Frutos-Vivar ◽  
Niall D. Ferguson ◽  
Andrés Esteban ◽  
Scott K. Epstein ◽  
Yaseen Arabi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Extubation Failure

Extubation Failure in Brain-injured Patients

2017 ◽  
Vol 126 (1) ◽  
pp. 104-114 ◽  
Author(s):  
Thomas Godet ◽  
Russell Chabanne ◽  
Julien Marin ◽  
Sophie Kauffmann ◽  
Emmanuel Futier ◽  
...  
Keyword(s):  
Predictive Value ◽  
Spontaneous Breathing Trial ◽  
Ventilatory Support ◽  
Extubation Failure ◽  
Predictive Score ◽  
Upper Airways ◽  
Neurologic Status ◽  
Brain Injured ◽  
Gag Reflex ◽  
Injured Patients

Abstract Background The decision to extubate brain-injured patients with residual impaired consciousness holds a high degree of uncertainty of success. The authors developed a pragmatic clinical score predictive of extubation failure in brain-injured patients. Methods One hundred and forty brain-injured patients were prospectively included after the first spontaneous breathing trial success. Assessment of multiparametric hemodynamic, respiratory, and neurologic functions was performed just before extubation. Extubation failure was defined as the need for ventilatory support during intensive care unit stay. Extubation failure within 48 h was also analyzed. Neurologic outcomes were recorded at 6 months. Results Extubation failure occurred in 43 (31%) patients with 31 (24%) within 48 h. Predictors of extubation failure consisted of upper-airway functions (cough, gag reflex, and deglutition) and neurologic status (Coma Recovery Scale-Revised visual subscale). From the odds ratios, a four-item predictive score was developed (area under the curve, 0.85; 95% CI, 0.77 to 0.92) and internally validated by bootstrap. Cutoff was determined with sensitivity of 92%, specificity of 50%, positive predictive value of 82%, and negative predictive value of 70% for extubation failure. Failure before and beyond 48 h shared similar risk factors. Low consciousness level patients were extubated with 85% probability of success providing the presence of at least two operating airway functions. Conclusions A simplified clinical pragmatic score assessing cough, deglutition, gag reflex, and neurologic status was developed in a preliminary prospective cohort of brain-injured patients and was internally validated (bootstrapping). Extubation appears possible, providing functioning upper airways and irrespective of neurologic status. Clinical practice generalizability urgently needs external validation.

scholarly journals Frequent tracheal suctioning is associated with extubation failure in patients with successful spontaneous breathing trial: a single-center retrospective cohort study

2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Junpei Haruna ◽  
Hiroomi Tatsumi ◽  
Satoshi Kazuma ◽  
Aki Sasaki ◽  
Yoshiki Masuda
Keyword(s):  
Mechanical Ventilation ◽  
Risk Factor ◽  
Spontaneous Breathing ◽  
Retrospective Cohort ◽  
Spontaneous Breathing Trial ◽  
Extubation Failure ◽  
Prolonged Stay ◽  
Sputum Volume ◽  
Tracheal Suctioning ◽  
Admission Type

Abstract Background Extubation failure, i.e., reintubation in ventilated patients, is a well-known risk factor for mortality and prolonged stay in the intensive care unit (ICU). Although sputum volume is a risk factor, the frequency of tracheal suctioning has not been validated as a predictor of reintubation. We conducted this study to examine whether frequent tracheal suctioning is a risk factor for reintubation. Patients and methods We included adult patients who were intubated for > 72 h in the ICU and extubated after completion of spontaneous breathing trial (SBT). We compared the characteristics and weaning-related variables, including the frequency of tracheal suctioning between patients who required reintubation within 24 h after extubation and those who did not, and examined the factors responsible for reintubation. Results Of the 400 patients enrolled, reintubation was required in 51 (12.8%). The most common cause of reintubation was difficulty in sputum excretion (66.7%). There were significant differences in sex, proportion of patients with chronic kidney disease, pneumonia, ICU admission type, the length of mechanical ventilation, and ICU stay between patients requiring reintubation and those who did not. Multivariate analysis showed frequent tracheal suction (> once every 2 h) and the length of mechanical ventilation were independent factors for predicting reintubation. Conclusion We should examine the frequency of tracheal suctioning > once every 2 h in addition to the length of mechanical ventilation before deciding to extubate after completion of SBT in patients intubated for > 72 h in the ICU.

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