Pressure support and positive end-expiratory pressure versus T-piece during spontaneous breathing trial in difficult weaning from mechanical ventilation: study protocol for the SBT-ICU study

Abstract

Background: Spontaneous breathing trials are performed in critically ill intubated patients in order to assess readiness to be weaned from mechanical ventilation. In patients with difficult weaning (i.e. not extubated after their first SBT), performing SBT using pressure support with or without positive end-expiratory pressure or using T-piece is debated. As ventilatory support during SBT is greater on pressure support than on T-piece and as positive end-expiratory pressure can prevent weaning-induced pulmonary oedema, we hypothesized that their combination and large use of post-extubation non-invasive ventilation may shorten the time until successful extubation as compared with T-piece, without increasing the rate of reintubation.

Methods: SBT-ICU is a monocentric prospective open labelled, randomized controlled superiority trial comparing two mechanical ventilation weaning strategies; i.e. daily spontaneous breathing trials using pressure support with positive end-expiratory pressure or T-piece. The primary outcome will be time until successful extubation (defined by as extubation, without reintubation or death within the seven following days).

Discussion: This paper describes the protocol of the SBT-ICU trial. Enrolment of patients in the study is ongoing.

Trial registration: ClinicalTrials.gov NCT03861117. Registered on March 1, 2019, before the beginning of inclusion.

Keywords: Critical care; Difficult weaning; Positive end-expiratory pressure; Spontaneous breathing trial; T-piece.

Fig. 1

Description of interventions according to allocated group. SBT-PS with PEEP: spontaneous breathing trial with pressure support and positive end-expiratory pressure. SBT-TP with PEEP: spontaneous breathing trial with T-piece. NIV: non-invasive ventilation. Post-extubation NIV criteria were: age>65 years, chronic heart or respiratory failure, PaCO₂ >45 mmHg during SBT, chronic obstructive pulmonary disease (COPD)