Original scientific paper
Chronic Obstructive Pulmonary Disease and Weaning of Difficult-to-wean Patients from Mechanical Ventilation: Randomized Prospective Study
Ivo Matić
Davorin Đanić
Višnja Majerić-Kogler
Matija Jurjević
Ivan Mirković
Natalija Mrzljak Vučinić
Abstract
Aim To compare T-tube and pressure support ventilation (PSV) as two methods of mechanical ventilation weaning of patients with chronic obstructive pulmonary disease (COPD) after failed extubation.
Methods A prospective randomized trial carried out at the multidisciplinary intensive care unit (ICU) over 2 years included 136 patients with COPD who required mechanical ventilation longer than 24 h. The patients who could be weaned from mechanical ventilation were randomized to either a T-tube or PSV 2-h spontaneous breathing trial. The patients in whom 2-h trial was successful were extubated and excluded from further research. Patients in whom 2-h trial failed had mechanical ventilation reinstated and underwent the same weaning procedure after 24 h in case they fulfilled the weaning criteria. The weaning outcome was assessed according to the following parameters: extubation success, mechanical ventilation duration, time spent in ICU, reintubation rate, and mortality rate.
Results Two-hour trial failed in 31 patients in T-tube and 32 patients in PSV group, of whom 17 and 23, respectively, were successfully extubated (P<0.001, χ²test). Mechanical ventilation lasted significantly longer in T-tube than in PSV group (187 h vs 163 h, respectively, P<0.001, Mann-Whitney test). Also, patients in T-tube group spent significantly more time in ICU than patients in PVS group (241 h [interquartile range 211-268] vs 210 h [211-268], respectively, P<0.001, Mann-Whitney test). Reintubation was required in 8 and 6 patients in T-tube and PVS group, respectively, and death occurred in 4 and 2 patients, respectively, during ICU stay.
Keywords
Respiration; COPD; Mechanical Ventilation; Ventilator Weaning; Respiratory Failure; ICU; Pressure Support Ventilation
Hrčak ID:
9407
URI
Publication date:
20.2.2007.
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