Ja. Farias et al., A comparison of two methods to perform a breathing trial before extubationin pediatric intensive care patients, INTEN CAR M, 27(10), 2001, pp. 1649-1654
Objective: To compare the percentage of infants and children successfully e
xtubated after a trial of breathing performed with either pressure support
or T-piece.
Design: Prospective and randomized study.
Setting: Three medical-surgical pediatric intensive care units (PICUs).
Patients: Two hundred fifty-seven consecutive infants and children who rece
ived mechanical ventilation for at least 48 h and were deemed ready to unde
rgo a breathing trial by their primary physician.
Interventions: Patients were randomly assigned to undergo a trial of breath
ing in one of two ways: pressure support of 10 cmH(2)O or T-piece. Bedside
measurements of respiratory function were obtained immediately before disco
ntinuation of mechanical ventilation and within the first 5 min of breathin
g through a T-piece. The primary physicians were unaware of those measureme
nts, and the decision to extubate a patient at the end of the breathing tri
al was made by them.
Measurements and main results: Of the 125 patients in the pressure support
group, 99 (79.2 %) completed the breathing trial and were extubated, but 15
of them (15.1 %) required reintubation within 48 h. Of the 132 patients in
the T-piece group, 102 (77.5 %) completed the breathing trial and were ext
ubated, but 13 of them (12.7 %) required reintubation within 48 h. The perc
entage of patients who remained extubated for 48 h after the breathing tria
l did not differ in the pressure support and T-piece groups (67.2 % versus
67.4 %, p = 0.97).
Conclusions: In infants and children mechanically ventilated, successful ex
tubation was achieved equally effectively after a first breathing trial per
formed with pressure support of 10 cmH(2)O or a T-piece.