Effect Of Different Ventilation Strategies During Spontaneous Breathing Trials On Successful Extubation Among Patients Receiving Mechanical Ventilation A Randomized Clinical Trial

Objective:To evaluate the effect of Pressure Support vs T-Piece vs Automatic Tube Compensation Ventilation Strategies During Spontaneous Breathing Trials on rates of successful extubation.Methods:69 cases of mechanically ventilated patients who were prepared to undergo the first spontaneous breathing trial(SBT)in EICU of an affiliated Hospital of Medical University from June 2020 to January 2021 were included.They were randomly divided into T-piece group,Pressure Support Ventilation(PSV)group and Automatic Tube Compensation(ATC)group for 30 minutes of SBT.After successful SBT,the tracheal intubation was removed within 24 hours.Observe the patients’Diaphragmatic Thickening Fraction(DTF)and Lung Ultrasound Scores(LUS)with ultrasound before the beginning of SBT(T0),at the end of SBT(T1)and 30 minutes after extubation(T2)in all patients;Follow-up within 48 hours of reintubation,the patient’s ICU hospital stay,total hospital stay,28-day mortality rate,and antibiotic use time,the data were analyzed statistically.Results:1.among the three groups,There were no significant differences in the successful SBT rates,reintubation rates,successful extubation rates,28-day mortality after SBT,median hospital length of stay,median intensive care unit length of stay and days of antibiotic use(P>0.05).2.Compared with patients with successful extubation,patients with failed extubation had higher LUS scores before and after SBT(P<0.05);there was no significant difference in DTF(P>0.05).3、Using T1-LUS,T1-LUS-AL to predict the reintubation,the AUC under the ROC curve are 0.860、0.876,and the P values are:0.003、0.005;the cut-off values are 15.5、9.5 respectively.4、Using T1-DTF to predict the reintubation,the AUC under the ROC curve is 0.684,and the P values is:0.147.5、At the end of SBT,the LUS of the three groups were not significantly different(P>0.05).the LUS of patients in T-piece,there was no significant difference in the changes from T1 to T2(P>0.05);the LUS of patients in the PSV group and ATC group increased from T1 to T2(P<0.05).5.The DTF of patients in the PSV group during the SBT process was significantly lower than that of the T-piece group and the ATC group(P<0.05),and there was no significant differences between the T-piece group and the ATC group(P>0.05);from T1 to T2,the T-piece group there was no significant difference in the change of DTF(P>0.05),the DTF in the PSV group and ATC group increased from T1 to T2(P<0.05).Conclusion(s):1.Among patients receiving mechanical ventilation,there is no difference on successful extubation of patients with these ventilation strategies of T-piece,PSV and ATC during spontaneous breathing trials.These findings support the use of above ventilation strategies for spontaneous breathing trials.2.In the process of SBT,the T-piece may better Simulate the real work of breath than PSV and ATC.3.To some extent,LUS-AL and LUS can be used for the prediction of patients’reintubation.