Chronic obstructive pulmonary disease and weaning of difficult-to-wean patients from mechanical ventilation: randomized prospective study
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. A prospective randomized trial carried out at the multidisciplinary intensive care unit (ICU) over 2 years...
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| Veröffentlicht in: | Croatian medical journal 2007-02, Vol.48 (1), p.51-58 |
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| creator | Matić, Ivo Danić, Davorin Majerić-Kogler, Visnja Jurjević, Matija Mirković, Ivan Mrzljak Vucinić, Natalija |
| description | 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.
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 hours. The patients who could be weaned from mechanical ventilation were randomized to either a T-tube or PSV 2-hour spontaneous breathing trial. The patients in whom 2-hour trial was successful were extubated and excluded from further research. Patients in whom 2-hour trial failed had mechanical ventilation reinstated and underwent the same weaning procedure after 24 hours 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.
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 |
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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 hours. The patients who could be weaned from mechanical ventilation were randomized to either a T-tube or PSV 2-hour spontaneous breathing trial. The patients in whom 2-hour trial was successful were extubated and excluded from further research. Patients in whom 2-hour trial failed had mechanical ventilation reinstated and underwent the same weaning procedure after 24 hours 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.
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, chi(2)test). Mechanical ventilation lasted significantly longer in T-tube than in PSV group (187 hours vs 163 hours, 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 hours [interquartile range 211-268] vs 210 hours [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.
Patients with COPD who failed the 2-hour spontaneous breathing trial had more favorable outcome when PVS rather than T-tube method was used for weaning from mechanical ventilation.</description><identifier>ISSN: 0353-9504</identifier><identifier>EISSN: 1332-8166</identifier><identifier>PMID: 17309139</identifier><language>eng</language><publisher>Croatia: Croatian Medical Schools</publisher><subject>Adult ; Aged ; Clinical Science ; Female ; Follow-Up Studies ; Humans ; Intensive Care Units ; Intubation, Intratracheal - instrumentation ; Male ; Middle Aged ; Positive-Pressure Respiration - instrumentation ; Positive-Pressure Respiration - methods ; Probability ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive - diagnosis ; Pulmonary Disease, Chronic Obstructive - therapy ; Respiration ; Respiration, Artificial - adverse effects ; Respiration, Artificial - methods ; Respiratory Function Tests ; Risk Factors ; Severity of Illness Index ; Statistics, Nonparametric ; Time Factors ; Treatment Outcome ; Ventilator Weaning - methods</subject><ispartof>Croatian medical journal, 2007-02, Vol.48 (1), p.51-58</ispartof><rights>Copyright © 2007 by the Croatian Medical Journal. All rights reserved. 2007</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080492/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080492/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17309139$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Matić, Ivo</creatorcontrib><creatorcontrib>Danić, Davorin</creatorcontrib><creatorcontrib>Majerić-Kogler, Visnja</creatorcontrib><creatorcontrib>Jurjević, Matija</creatorcontrib><creatorcontrib>Mirković, Ivan</creatorcontrib><creatorcontrib>Mrzljak Vucinić, Natalija</creatorcontrib><title>Chronic obstructive pulmonary disease and weaning of difficult-to-wean patients from mechanical ventilation: randomized prospective study</title><title>Croatian medical journal</title><addtitle>Croat Med J</addtitle><description>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.
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 hours. The patients who could be weaned from mechanical ventilation were randomized to either a T-tube or PSV 2-hour spontaneous breathing trial. The patients in whom 2-hour trial was successful were extubated and excluded from further research. Patients in whom 2-hour trial failed had mechanical ventilation reinstated and underwent the same weaning procedure after 24 hours 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.
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, chi(2)test). Mechanical ventilation lasted significantly longer in T-tube than in PSV group (187 hours vs 163 hours, 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 hours [interquartile range 211-268] vs 210 hours [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.
Patients with COPD who failed the 2-hour spontaneous breathing trial had more favorable outcome when PVS rather than T-tube method was used for weaning from mechanical ventilation.</description><subject>Adult</subject><subject>Aged</subject><subject>Clinical Science</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Intubation, Intratracheal - instrumentation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Positive-Pressure Respiration - instrumentation</subject><subject>Positive-Pressure Respiration - methods</subject><subject>Probability</subject><subject>Prospective Studies</subject><subject>Pulmonary Disease, Chronic Obstructive - diagnosis</subject><subject>Pulmonary Disease, Chronic Obstructive - therapy</subject><subject>Respiration</subject><subject>Respiration, Artificial - adverse effects</subject><subject>Respiration, Artificial - methods</subject><subject>Respiratory Function Tests</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Statistics, Nonparametric</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Ventilator Weaning - methods</subject><issn>0353-9504</issn><issn>1332-8166</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkEtLxDAUhYsozvj4C5KVu0JeTRMXggy-YMCNrkuaJjORNqlJOjL-A_-1kRlFVxfOuXznnntQzBEhuOSIscNiDklFSlFBOitOYnyFEENK2XExQzWBAhExLz4X6-CdVcC3MYVJJbvRYJz6wTsZtqCzUcuogXQdeNfSWbcC3mTZGKumPpXJl986GGWy2qUITPADGLRa52Ule7DJqu2z690VCJnjB_uhOzAGH0e9y4tp6rZnxZGRfdTn-3lavNzdPi8eyuXT_ePiZlmOmNFUCsEhaitDGTSqqngtKKq1NkwrTIziuTLiiLcEIiGYMHXXVpRgnq2aSCjIaXG9445TO-hO5fuC7Jsx2CE3bry0zX_H2XWz8psGQw6pwBlwuQcE_zbpmJrBRqX7Xjrtp9gwATFm4jvp4m_Sb8TP98kXHS2Gqw</recordid><startdate>200702</startdate><enddate>200702</enddate><creator>Matić, Ivo</creator><creator>Danić, Davorin</creator><creator>Majerić-Kogler, Visnja</creator><creator>Jurjević, Matija</creator><creator>Mirković, Ivan</creator><creator>Mrzljak Vucinić, Natalija</creator><general>Croatian Medical Schools</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>200702</creationdate><title>Chronic obstructive pulmonary disease and weaning of difficult-to-wean patients from mechanical ventilation: randomized prospective study</title><author>Matić, Ivo ; Danić, Davorin ; Majerić-Kogler, Visnja ; Jurjević, Matija ; Mirković, Ivan ; Mrzljak Vucinić, Natalija</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p264t-99801b5f460fc55879417eef6ec23fc83531818b3019969f7db54328fc873a093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Clinical Science</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Intubation, Intratracheal - instrumentation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Positive-Pressure Respiration - instrumentation</topic><topic>Positive-Pressure Respiration - methods</topic><topic>Probability</topic><topic>Prospective Studies</topic><topic>Pulmonary Disease, Chronic Obstructive - diagnosis</topic><topic>Pulmonary Disease, Chronic Obstructive - therapy</topic><topic>Respiration</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Respiration, Artificial - methods</topic><topic>Respiratory Function Tests</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Statistics, Nonparametric</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Ventilator Weaning - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Matić, Ivo</creatorcontrib><creatorcontrib>Danić, Davorin</creatorcontrib><creatorcontrib>Majerić-Kogler, Visnja</creatorcontrib><creatorcontrib>Jurjević, Matija</creatorcontrib><creatorcontrib>Mirković, Ivan</creatorcontrib><creatorcontrib>Mrzljak Vucinić, Natalija</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Croatian medical journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Matić, Ivo</au><au>Danić, Davorin</au><au>Majerić-Kogler, Visnja</au><au>Jurjević, Matija</au><au>Mirković, Ivan</au><au>Mrzljak Vucinić, Natalija</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chronic obstructive pulmonary disease and weaning of difficult-to-wean patients from mechanical ventilation: randomized prospective study</atitle><jtitle>Croatian medical journal</jtitle><addtitle>Croat Med J</addtitle><date>2007-02</date><risdate>2007</risdate><volume>48</volume><issue>1</issue><spage>51</spage><epage>58</epage><pages>51-58</pages><issn>0353-9504</issn><eissn>1332-8166</eissn><abstract>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.
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 hours. The patients who could be weaned from mechanical ventilation were randomized to either a T-tube or PSV 2-hour spontaneous breathing trial. The patients in whom 2-hour trial was successful were extubated and excluded from further research. Patients in whom 2-hour trial failed had mechanical ventilation reinstated and underwent the same weaning procedure after 24 hours 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.
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, chi(2)test). Mechanical ventilation lasted significantly longer in T-tube than in PSV group (187 hours vs 163 hours, 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 hours [interquartile range 211-268] vs 210 hours [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.
Patients with COPD who failed the 2-hour spontaneous breathing trial had more favorable outcome when PVS rather than T-tube method was used for weaning from mechanical ventilation.</abstract><cop>Croatia</cop><pub>Croatian Medical Schools</pub><pmid>17309139</pmid><tpages>8</tpages></addata></record> |
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| subjects | Adult Aged Clinical Science Female Follow-Up Studies Humans Intensive Care Units Intubation, Intratracheal - instrumentation Male Middle Aged Positive-Pressure Respiration - instrumentation Positive-Pressure Respiration - methods Probability Prospective Studies Pulmonary Disease, Chronic Obstructive - diagnosis Pulmonary Disease, Chronic Obstructive - therapy Respiration Respiration, Artificial - adverse effects Respiration, Artificial - methods Respiratory Function Tests Risk Factors Severity of Illness Index Statistics, Nonparametric Time Factors Treatment Outcome Ventilator Weaning - methods |
| title | Chronic obstructive pulmonary disease and weaning of difficult-to-wean patients from mechanical ventilation: randomized prospective study |
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