Comparison of extubation outcomes following T-piece trial versus pressure support/continous positive airway pressure in postsurgical patients

• Main Authors: Lakshmi Kumar, A R Meghalakshmi, Anu Vasudevan, Sunil Rajan, Jerry Paul
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Indian Journal of Respiratory Care
• Subjects: Extubation; pressure support-continuous positive airway pressure; T-piece trials
• Online Access: http://www.ijrconline.org/article.asp?issn=2277-9019;year=2018;volume=7;issue=1;spage=37;epage=41;aulast=Kumar
• ISSN: 2277-9019; 2321-4899

Background: Pressure support with continuous positive airway pressure (CPAP) and T-piece trials are the most common spontaneous breathing trial used to test readiness for extubation. Aim: We aimed to compare extubation failures defined by the need for reintubation within 48 h following T-piece trial versus extubation directly from pressure support (PS) ventilation in postoperative patients. Patients and Methods: This was a prospective cross-sectional study conducted in the postsurgical patients. Hemodynamic parameters and respiratory variables were measured before and after weaning trials. Outcomes after extubation, need for noninvasive-assist ventilation following extubation, duration of oxygen therapy, and time of shifting from the Intensive Care Unit (ICU) were also recorded. Results: Fifty patients needed mechanical ventilation postoperatively were recruited for the study. No significant differences were seen in the rate of extubation failures between PS- and T-piece groups. Rapid shallow breathing index recorded at the start of weaning was significantly higher in the T-piece group (P < 0.001). The respiratory rate (RR) and heart rate (HR) were significantly higher (P < 0.001) and saturation lower (P = 0.035) in the group on T-piece trial. The need for respiratory assist devices, oxygenation index, length of ICU stay, duration of oxygen therapy, and mortality were comparable between the two groups. Conclusions: Outcomes of weaning are similar between T piece and CPAP/PS in patients undergoing postoperative mechanical ventilation. Weaning on T piece is associated with higher RR, HR, rapid shallow breathing, and lower saturation than weaning from CPAP/PS but does not affect the length of ICU stay, need for oxygen therapy, or mortality.