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Article Dans Une Revue New England Journal of Medicine Année : 2022

Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece

1 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
2 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
5 CIC - Centre d’Investigation Clinique [Tours] CIC 1415
6 Pathologies Respiratoires : Protéolyse et Aérosolthérapie
7 CHU Dijon
8 CIC-EC - Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques
9 CHRO - Centre Hospitalier Régional d'Orléans
10 Centre Hospitalier Le Mans (CH Le Mans)
11 Centre Hospitalier Victor Dupouy
12 CH E.Muller Mulhouse - Centre Hospitalier Emile Muller [Mulhouse]
13 CHU Nantes - Centre Hospitalier Universitaire de Nantes
14 Centre Hospitalier Henri Mondor d'Aurillac
15 Hôpital Charles Nicolle [Rouen]
16 GRHVN - Groupe de Recherche sur le Handicap Ventilatoire et Neurologique
17 Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion]
18 CHU Nice - Centre Hospitalier Universitaire de Nice
19 URRIS UR2CA - Unité de Recherche Clinique de la Côte d’Azur
20 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
21 CHV - Centre Hospitalier de Versailles André Mignot
22 CHBBF - Centre Hospitalier Fleyriat [Bourg en Bresse]
23 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
24 HP2 - Hypoxie et PhysioPathologie
25 GHBS - Groupe Hospitalier Bretagne Sud
26 IC UM3 (UMR 8104 / U1016) - Institut Cochin
27 Hôpital Cochin [AP-HP]
28 Centre hospitalier de Pau
29 Centre Hospitalier Loire Vendée Océan
30 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
31 UGSF - Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576
32 Hôpital Foch [Suresnes]
33 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
34 CHU Pitié-Salpêtrière [AP-HP]
35 TIMONE - Hôpital de la Timone [CHU - APHM]
36 UNICANCER/CJP - Centre Jean Perrin [Clermont-Ferrand]
Damien Contou
Jean-Paul Mira
  • Fonction : Auteur
  • PersonId : 928244
Alexandre Lautrette

Résumé

Background: Spontaneous-breathing trials can be performed with the use of either pressure-support ventilation (PSV) or a T-piece. Whether PSV trials may result in a shorter time to tracheal extubation than T-piece trials, without resulting in a higher risk of reintubation, among patients who have a high risk of extubation failure is unknown. Methods: In this multicenter, open-label trial, we randomly assigned patients who had a high risk of extubation failure (i.e., were >65 years of age or had an underlying chronic cardiac or respiratory disease) to undergo spontaneous-breathing trials performed with the use of either PSV (with a pressure-support level of 8 cm of water and no positive end-expiratory pressure) or a T-piece. The primary outcome was the total time without exposure to invasive ventilation (reported as the number of ventilator-free days) at day 28 after the initial spontaneous-breathing trial. Secondary outcomes included extubation within 24 hours and extubation within 7 days after the initial spontaneous-breathing trial, as well as reintubation within 7 days after extubation. Results: A total of 969 patients (484 in the PSV group and 485 in the T-piece group) were included in the analysis. At day 28, the median number of ventilator-free days was 27 (interquartile range, 24 to 27) in the PSV group and 27 (interquartile range, 23 to 27) in the T-piece group (difference, 0 days; 95% confidence interval [CI], -0.5 to 1; P = 0.31). Extubation was performed within 24 hours in 376 patients (77.7%) in the PSV group and in 350 patients (72.2%) in the T-piece group (difference, 5.5 percentage points; 95% CI, 0.01 to 10.9), and extubation was performed within 7 days in 473 patients (97.7%) and 458 patients (94.4%), respectively (difference, 3.3 percentage points; 95% CI, 0.8 to 5.9). Reintubation was performed in 72 of 481 patients (14.9%) in the PSV group and in 65 of 477 patients (13.6%) in the T-piece group (difference, 1.3 percentage points; 95% CI, -3.1 to 5.8). Cardiac or respiratory arrest was a reason for reintubation in 9 patients (3 in the PSV group and 6 in the T-piece group). Conclusions: Among patients who had a high risk of extubation failure, spontaneous-breathing trials performed with PSV did not result in significantly more ventilator-free days at day 28 than spontaneous-breathing trials performed with a T-piece. (Supported by the French Ministry of Health; TIP-EX ClinicalTrials.gov number, NCT04227639.).
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Dates et versions

hal-03857047 , version 1 (17-11-2022)

Identifiants

Citer

Arnaud Thille, Arnaud Gacouin, Rémi Coudroy, Stephan Ehrmann, Jean-Pierre Quenot, et al.. Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece. New England Journal of Medicine, 2022, 387 (20), pp.1843-1854. ⟨10.1056/NEJMoa2209041⟩. ⟨hal-03857047⟩
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