ABSTRACT
Objetivo: Determinar si el ensayo de respiración espontánea con presión positiva continua de la vía aérea (CPAP) es superior al ensayo con Tubo en T en pacientes con EPOC. Diseño: Ensayo clínico ciego con distribución aleatoria. Ámbito: Tres UCI médico quirúrgicas. Pacientes: Muestra aleatoria de 50 pacientes con EPOC en ventilación mecánica (VM) por más de 48 horas con criterios para la liberación de la VM: resolución de la exacerbación del EPOC, Glasgow >10, temperatura <38oC, cociente PaO2/FiO2 <150con un PEEP <5cm H2O y FiO2 <50%, Hb >10g/dl, ninguna necesidad de vasoactivos (excepto dopamina <5μg/kg/min o dobutamina <5μg/kg/min) ni agentes sedantes y tos eficaz. Intervención: Ensayo de respiración espontánea de 30min con sistema de Tubo en T o CPAP. Variables: Éxito en la liberación de la VM, éxito en el ensayo de respiración espontánea, reincubación y PEEP intrínseca. Resultados: De los 25 pacientes asignados al grupo de Tubo en T, 18 terminaron con éxito el ensayo y fueron extubados; 3 de ellos requirieron reintubación. De los 25 pacientes asignados al grupo de CPAP, 19 fueron extubados y ninguno requirió reintubación. El éxito en la liberación de la VM fue de 76% en CPAP y 60% en Tubo en T (riesgo relativo 1,27; intervalo de confianza del 95%, 0,86-1,87). Conclusión: En una cohorte de pacientes con EPOC, el ensayo de respiración espontánea con CPAP tuvo una tendencia a mejor resultado que con Tubo en T, pero esto necesita mayor investigación (AU)
Objective: To determine if the spontaneous breathing trial (SBT) with continuous positive airway pressure (CPAP) is superior to SBT with a T-piece in patients with Chronic Obstructive Pulmonary Disease (COPD). Design: A blind clinical test with random distribution. Setting: Three medical-surgical intensive care units. Patients: A random sample of 50 patients with COPD who had received mechanical ventilation for more than 48 hours and who were considered to fulfill weaning criteria: resolution of the exacerbation of the COPD disease, Glasgow scale >10, temperature < 38oC, PaO2 /FiO2 quotient >150 with an external PEEP <5cm H2O and FiO2 < to 50%, hemoglobin >10g/dl, no need for vasoactive drugs (except for dopamine <5μg/kg/min or dobutamine <5μg/kg/min) or for sedative agents and effective cough. Intervention A 30-minute spontaneous respiration trial with T-piece system or CPAP. Variables: Successful weaning from mechanical ventilation, successful SBT, reintubation and intrinsic PEEP. Results: Out of 25 patients who were assigned to the T-tube group, 18 successfully completed the trial and were extubated; 3 of them requiring reintubation. Out of 25 patients who were assigned to the CPAP group, 19 were extubated and none of them required reintubation. There was successful weaning from mechanical ventilation in 76% in SBT-CPAP vs 60% in SBT-TT (relative risk 1.27; 95% confidence interval 0.86 to 1.87). Conclusion: In a COPD patient cohort, the performance of spontaneous breathing with CPAP showed a tendency to better outcome than with T-Piece, however, further research is needed (AU)
Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/therapy , Positive-Pressure Respiration , Intubation, Intratracheal , Respiration, Artificial/methods , Ventilator WeaningABSTRACT
OBJECTIVE: To determine if the spontaneous breathing trial (SBT) with continuous positive airway pressure (CPAP) is superior to SBT with a T-piece in patients with Chronic Obstructive Pulmonary Disease (COPD). DESIGN: A blind clinical test with random distribution. SETTING: Three medical-surgical intensive care units. PATIENTS: A random sample of 50 patients with COPD who had received mechanical ventilation for more than 48 hours and who were considered to fulfill weaning criteria: resolution of the exacerbation of the COPD disease, Glasgow scale >10, temperature ≤ 38°C, PaO(2) /FiO(2) quotient >150 with an external PEEP ≤5cm H(2)O and FiO(2) ≤ to 50%, hemoglobin >10g/dl, no need for vasoactive drugs (except for dopamine ≤5µg/kg/min or dobutamine ≤5µg/kg/min) or for sedative agents and effective cough. INTERVENTION: A 30-minute spontaneous respiration trial with T-piece system or CPAP. VARIABLES: Successful weaning from mechanical ventilation, successful SBT, reintubation and intrinsic PEEP. RESULTS: Out of 25 patients who were assigned to the T-tube group, 18 successfully completed the trial and were extubated; 3 of them requiring reintubation. Out of 25 patients who were assigned to the CPAP group, 19 were extubated and none of them required reintubation. There was successful weaning from mechanical ventilation in 76% in SBT-CPAP vs 60% in SBT-TT (relative risk 1.27; 95% confidence interval 0.86 to 1.87). CONCLUSION: In a COPD patient cohort, the performance of spontaneous breathing with CPAP showed a tendency to better outcome than with T-Piece, however, further research is needed.
