T-piece improves arterial and central venous oxygenation in trachestomized patients as compared to continuous positive airway pressure/pressure support ventilation

A. Lovas, Z. Molnár

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5 Citations (Scopus)

Abstract

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 (t 1), 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. PaO 2/FiO2 was significantly higher on T-piece (t 3,4) then on CPAP (t0,1), P<0.05, PaO 2/FiO2 did not change significantly on CPAP+PS (t 0) 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, respectiv ely. ScvO2 was significantly higher on T-piece at t 4: 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.

Original languageEnglish
Pages (from-to)492-497
Number of pages6
JournalMinerva Anestesiologica
Volume79
Issue number5
Publication statusPublished - May 1 2013

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Keywords

  • Continuous positive airway pressure
  • Positive-pressure respiration
  • Tracheostomy
  • Ventilator weaning

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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