Spontaneous breathing trials: how and for how long?

IF 3.5 3区医学 Q1 CRITICAL CARE MEDICINE

Current Opinion in Critical Care Pub Date : 2024-10-24 DOI:10.1097/MCC.0000000000001227

Arnaud W Thille, François Arrivé, Sylvain Le Pape

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引用次数: 0

Abstract

Purpose of review: Guidelines recommend systematic performance of a spontaneous breathing trial (SBT) before extubation in ICUs, the objective being to reduce the risk of reintubation. In theory, a more challenging SBT performed with a T-piece may further reduce the risk of reintubation, whereas a less challenging SBT performed with pressure-support ventilation (PSV) may hasten extubation.

Recent findings: Recent findings show that a more challenging SBT with a T-piece or for a prolonged duration do not help to reduce the risk of reintubation. In contrast, a less challenging SBT with PSV is easier to pass than a T-piece, and may hasten extubation without increased risk of reintubation. Although SBT with PSV and additional positive end-expiratory pressure is indeed a less challenging SBT, further studies are needed to generalize such an easy trial in daily practice. Earlier screening for a first SBT may also decrease time to extubation without increased risk of reintubation. Lastly, reconnection to the ventilator for a short period after successful SBT facilitates recovery from the SBT-induced alveolar derecruitment.

Summary: Several recent clinical trials have improved assessment of the most adequate way to perform SBT before extubation.

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自主呼吸试验：如何进行，持续多久？

审查目的：指南建议在 ICU 拔管前系统地进行自主呼吸试验（SBT），目的是降低再次插管的风险。从理论上讲，使用 T-piece进行更具挑战性的 SBT 可进一步降低再次插管的风险，而使用压力支持通气（PSV）进行挑战性较低的 SBT 可加速拔管：最新研究结果表明，使用 T-piece或持续时间较长的高难度 SBT 无助于降低再次插管的风险。相比之下，使用 PSV 的难度较低的 SBT 比使用 T 型气管插管更容易通过，并且可以加快拔管，而不会增加再次插管的风险。虽然使用 PSV 和额外的呼气末正压的 SBT 确实是一种难度较低的 SBT，但要在日常实践中推广这种简单的试验还需要进一步的研究。在不增加再次插管风险的情况下，更早地进行首次 SBT 筛选也可缩短拔管时间。最后，在 SBT 成功后短时间内重新连接呼吸机有助于从 SBT 引起的肺泡扩张中恢复过来。摘要：最近的几项临床试验改进了对拔管前进行 SBT 的最适当方法的评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Critical Care 医学-危重病医学

CiteScore

5.90

自引率

3.00%

发文量

172

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.