Comparative Efficacy of SPONTANEOUS BREATHING TRIAL Techniques in Mechanically Ventilated Adult Patients A Review
Comparative Efficacy of SPONTANEOUS BREATHING TRIAL Techniques in Mechanically Ventilated Adult Patients A Review
Comparative Efficacy of SPONTANEOUS BREATHING TRIAL Techniques in Mechanically Ventilated Adult Patients A Review
ISSN No:-2456-2165
Abstract:- Since the invention of mechanical ventilation intubation times to a minimum. To reduce risk of tracheotomy
and the development of critical care medicine, weaning and delayed weaning, prolonged mechanical breathing,
literature and research have transformed daily patient defined as more than 14 days of intubation, is typically
treatment in intensive care units. More study on weaning avoided unless absolutely required. [2] Early extubation has
trials has become important as our understanding of been proven to improve the patient's prognosis.
mechanical breathing with the use of mechanical
ventilators has grown. Studies tended to concentrate on the The researcher’s objective is to compare the efficacy of
length of mechanical ventilation utilizing different methods spontaneous breathing trial techniques with the use of
for conducting spontaneous breathing trials as a means of synchronized intermittent mandatory ventilation (SIMV),
weaning patients from assisted ventilation. pressure support ventilation, and T-piece/T-tube trials for adult
patients weaning from mechanical ventilation according to
This article review offers a comprehensive look at the mortality, weaning failure, re-intubation, and weaning
effectiveness of weaning using spontaneous breathing trials duration. [3]
with pressure support ventilation (PSV), synchronized
intermittent mandatory ventilation (SIMV), and T-tube or II. METHODS
T-piece trials.
The researchers of this study conducted a systematic
Keywords:- Weaning; Mechanical Ventilation Weaning; literature search on PubMed from their inception until
Mechanical Ventilation; Spontaneous Breathing Trial; SBT; February 28, 2023. No restriction on language was imposed.
Spontaneous Breathing Trial Techniques The search process employed several combinations of specific
keywords based on the principle of combination of medical
I. INTRODUCTION subject heading and text words: “ventilator weaning”,
spontaneous breathing trial”, “mechanical ventilation”, and
Several ventilatory support techniques have been other terms related to weaning modalities. Any disagreements
proposed to assist patients in gradually weaning themselves about the study retrieval were solved based on the consensus
off mechanical ventilation. However, it is unknown how between the 4 authors of this study.
effective these techniques will be when used in a medical
setting. Only a few of the identified ventilatory support III. LITERATURE SEARCH
techniques have passed as a theory.
Spontaneous Breathing Trials
By quickly identifying patients who are capable of The spontaneous breathing trial (SBT) evaluates the
spontaneous breathing, the duration of mechanical ventilation likelihood that a patient can effectively wean off of invasive
may be reduced, and complications related to artificial mechanical ventilation by using a T-tube or modest
ventilation may also be reduced. [1] Weaning off artificial spontaneous breathing support. [2] If a patient is declared ready
breathing is done in the intensive care unit (ICU) using a step- to breathe independently, this screening technique is routinely
by-step procedure that is well recognized to all primary health performed. Typically, a T-piece is affixed to the patient’s
workers who work closely with the mechanically ventilated endotracheal tube when the patient is taken off the ventilator
patients. Despite the fact the intubation is required to protect to assume all of the work of breathing.
the airways and stop central hypoventilation, the respiratory
therapists face a problem while weaning patients off of
mechanical ventilation because it is important to keep
Table 1: Comparative Efficacy of Spontaneous Breathing Trial Techniques in Mechanically Ventilated Adult Patients
Author & Year Origin Article Title Results/Discussion
Ye Xiaomei, Waters David & Yu China The Effectiveness of Pressure When all four results of the study were looked
Hong-Jing (2022) Support Ventilation and T-piece at together, those who were thought to be easy
in differing duration among to wean did better after 30 minutes of pressure
weaning patients: A systematic support ventilation. Also, a 120-minute T-
review and network meta- piece trial and 120-minute pressure support
analysis ventilation are more likely to lead to a lower
rate of reintubation. So, weaning time is
thought to be more important for people who
are more likely to need a breathing tube again.
[8]
Li Yuting, Li Hongxiang & Zhang China Comparison of T-piece and In patients who are very critical, T-piece trial
Dong (2020) pressure support ventilation as and pressure support ventilation as
spontaneous breathing trials in spontaneous breathing trial technique are
critically ill patients; a thought to have the same effect. The authors
systematic review and meta- were firm that there were no clear difference
analysis between the rates of patient being reintubated,
length of stay in the critical care unit and
hospital, or rates of mortality in the critical
care unit and hospital. [9]
Na Soo Jin, Ko Ryoung-Eun, Nam Republic of Comparison Between Pressure In critical patients, spontaneous breathing trial
Jimyoung, Ko Myeong Gyun & Jeon Korea Support Ventilation and T-piece using pressure support was not linked to a
Kyeongnam (2022) in Spontaneous Breathing Trials higher rate of successful weaning than using
T-piece trial. But it was decided that pressure
support ventilation could speed up the
weaning process without increasing the risk of
having to put the tube back in. [10]
Subira Carles, Hernandez Gonzalo, Spain Effect of Pressure Support vs T- A spontaneous breathing test with 30-minutes
Vazquez Antionia, et. al (2019) piece Ventilation Strategies of pressure support ventilation compared to 2
During Spontaneous Breathing hours of T-piece trial led to a huge increase in
Trials on Successful Extubation the number of patients who were able to get
Among Patients Receiving rid of the breathing machines. The results
Mechanical Ventilation: A show that a less difficult way to breathe
Randomized Clinical Trial should be used when testing patients’ ability
to breathe on their own. [11]
Pellegrini Jose Augusto, Boniatti Brazil Pressure-support Ventilation or The study found that trying to breathe on your
Marcio Manozzo, Boniatti Viviane T-piece Spontaneous Breathing own using spontaneous breathing trial
Correa, et. al (2018) Trials for Patients with Chronic technique didn’t change how long you had to
Obstructive Pulmonary Disease use mechanical ventilation. The use of T-piece
– A Randomized Controlled trial may make it longer to get hard-to-wean
Trial patients off of mechanical ventilators. [12]
Mancebo Jordi, Golgher Ewan & Spontaneous Breathing Trials The results of the clinical trial, which was
Borchard Laurent (2019) and Successful Extubation randomized, compared to 30-minute
spontaneous breathing trial using pressure
support mode was less difficult. When
spontaneous breathing trial was done with T-
piece, the rate of successful extubation was
higher. It is thought to be an easier method
that doesn’t increase the risk of reintubation.
[13]
Zein Hossam, Baratloo Alireza, Egypt Ventilator Weaning and Spontaneous breathing trials evaluates the
Negida Ahmed, Safari Saeed, et. al Spontaneous Breathing Trials; patient’s ability to breathe on his or her own
(2016) an Educational Review with minimal to no ventilatory support. The
collective task force stated in 2001 that the
process of breathing trials and weaning should
begin with determining whether or not the
patient’s underlying cause of respiratory
failure has been addressed and resolved.
Weaning predictors are parameters introduced
to assist clinicians in predicting whether or not
weaning attempts will be successful. [14]
Thille, A. W., Coudroy, R., Gacouin, France T-piece versus pressure-support The experiment was started by the researches
A., Ehrmann, S., Contou, D., ventilation for spontaneous to see if pressure support ventilation could
Dangers, L., Frat, J.-P. (2020) breathing trials before speed up the extubation and reduce the
extubation in patients at high number of high-risk patients who needed to be
risk of reintubation: protocol for re-intubated faster than T-piece. Both of the
a multicentre, randomized techniques mentioned in the experiment have
controlled trial (TIP-EX) never been tested on patients who are at a high
risk for re-intubation which makes the study
very important for making good decisions and
everyday recommendations about extubation
in the intensive care unit. [15]
Chatburn Robert, Lui Ping-Hui, et. al Cleveland, The Evolution of Intermittent Over time, intermittent mandatory ventilation
(2022) Ohio Mandatory Ventilation has changed into four different types with
each of the technique to have its own pros and
cons for achieving the intended objectives of
mechanical ventilation, which are mostly to
keep the patient safe and comfortable. [16]
Dadam, M. M., Gonçalves, A. R. R., Brazil The Effect of Reconnection to The research shows that hooking up the
Mortari, G. L., Klamt, A. P., Hippler, Mechanical Ventilation for 1 patient to the mechanical ventilator for one
A., Lago, J. U., … Westphal, G. A. Hour After Spontaneous hour after a successful spontaneous breathing
(2021) Breathing Trial on Reintubation test didn’t have any statistically significant
Among Patients Ventilated for results or a big effect on the main goal of the
More Than 12 Hours. proponents. The results were good for
reintubation within the first 48 hours when the
patient had been on mechanical ventilation for
more than 72 hours before being taken off the
ventilator. So, it is possible that people who
have been using mechanical ventilation for a
long time may benefit more from this. But this
action needs to be checked with follow-up
research that is the right size and focuses on
the right people. [17]
Thille, A. W., Coudroy, R., Nay, M.- France Pressure-support ventilation The study showed that the first spontaneous
A., Gacouin, A., Demoule, A., versus T-piece during breathing trial using pressure support mode in
Sonneville, R., Frat, J.-P. (2020) spontaneous breathing trials critical patients who are at high risk for
before extubation among extubation failures went by a lot. Using
patients at high-risk of pressure support mode, weaning could speed
extubation failure: a post-hoc up extubation without increasing the risk of
analysis of a clinical trial. having to put the tube back in. This is another
important result that could happen in the
future but more study needs to be done to
confirm these results in high-risk groups
before this can be used as part of the plan to
wean all mechanically ventilated patients in
the intensive care unit. [18]