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Lovas A., Molnár Z.
Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
Background: T-piece has been widely used as T-piece trial to identify patients who are ready for extubation but it is seldom used as a weaning tool. Our objective was to investigate the effects of breathing via T-piece on gas exchange as compared to continuous positive airway pressure with pressure support (CPAP+PS) and CPAP with automatic tube compensation (CPAP+ATC) as it has not been evaluated yet.
Methods: Tracheostomized, “ready to be weaned” critically ill patients were enrolled in this prospective, auto-control clinical trial. Arterial oxygen tension (PaO2) was determined on CPAP+PS (t0), 15 minutes later on CPAP+ATC (t1), then on T-piece at 15, 30 and 60 minutes (t2-4). ScvO2 was measured at t0 and t4. Settings of fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP) were kept constant throughout the investigation.
Results: Twenty-five patients were enrolled. T-piece trial was interrupted in 4 cases after t2, due to pulmonary oedema, hypertension or fatigue. PaO2/FiO2 was significantly higher on T-piece (t3,4) then on CPAP (t0,1), P<0.05, PaO2/FiO2 did not change significantly on CPAP+PS (t0) vs. CPAP+ATC (t1) modes: median=208 (interquartile range: 175-266) vs. 223 (186-290) mmHg, P=0.102, but significantly increased from t0-t4: 208 (175-266) vs. 249 (215-325) mmHg, P=0.003, respectively. ScvO2 was significantly higher on T-piece at t4: 80% (75-82%) than on CPAP+PS at t0: 73% (71-78%), P<0.001.
Conclusion: On the same FiO2 and PEEP setting, breathing via T-piece improved oxygenation and resulted in increased ScvO2 as compared to breathing on CPAP with PS. Our observations suggest a potential role of T-piece during weaning from mechanical ventilation.