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Randomized Controlled Trial
. 2024 Dec;50(12):2083-2093.
doi: 10.1007/s00134-024-07657-4. Epub 2024 Oct 25.

Spontaneous breathing trials should be adapted for each patient according to the critical illness. A new individualised approach: the GLOBAL WEAN study

Mathieu Capdevila  1   2 , Yassir Aarab  1   3 , Clement Monet  1 , Audrey De Jong  1   2 , Aurelie Vonarb  1 , Julie Carr  1 , Nicolas Molinari  4 , Xavier Capdevila  5   6 , Laurent Brochard  7   8 , Samir Jaber  9   10
Affiliations
Randomized Controlled Trial

Spontaneous breathing trials should be adapted for each patient according to the critical illness. A new individualised approach: the GLOBAL WEAN study

Mathieu Capdevila et al. Intensive Care Med. 2024 Dec.

Abstract

Purpose: Spontaneous breathing trials (SBT) evaluate the patient's capacity to maintain inspiratory effort after extubation. SBT practices are heterogeneous and not individualised. The objective of this study was to assess which SBT best reproduces inspiratory effort after extubation in five critical illnesses.

Methods: In this multicentre randomized cross-over study, adult intensive care unit patients under invasive mechanical ventilation for at least 24-h and ready for extubation, underwent three 15-min SBTs in random order: pressure support ventilation level of 7-cmH2O with positive end-expiratory pressure (PEEP) level of 0-cmH2O (PSV7PEEP0), PSV 0-cmH2O with PEEP 0-cmH2O (PSV0PEEP0) and T-piece trial. Primary outcome was the variation of pressure-time-product per minute (PTPmin) between each SBT and 20-min after extubation. Five categories of critical illnesses were selected: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease (COPD) and miscellaneous.

Results: Five hundred measures of effort from 100 patients were analysed. PTPmin (cmH2O s/min, median and interquartile range, IQR) was 256 (208-321) after extubation, 192 (127-281) at the end of PSV7PEEP0 (p < 0.001 in comparison to after extubation), 291 (235-347) at the end of PSV0PEEP0 and 262 (198-338) at the end of T-piece (both no different from after extubation). One method of SBT in patients with brain injury (PSV0PEEP0), two in abdominal surgery (PSV0PEEP0 and T-piece) and miscellaneous patients (PSV7PEEP0 and T-piece) and all three methods in chest trauma and COPD exacerbation patients replicated reasonably accurately the postextubation effort to breathe.

Conclusion: Unassisted SBTs, namely PSV0PEEP0 and T-piece trial, are the most appropriate to replicate the postextubation effort to breathe.

Keywords: Mechanical ventilation; Spontaneous breathing trial; Weaning.

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Conflict of interest statement

Declarations. Conflict of interest: ADJ reports receiving consulting fees from Drager, Medtronic and Fisher & Paykel. LB’s lab has received research grants from Medtronic, Drager and Stimit and equipment from Sentec, Fisher & Paykel and Philips and lecture fees from Fisher & Paykel. SJ reports receiving consulting fees from Drager, Mindray, Medtronic, Baxter, Fresenius-Xenios and Fisher & Paykel. No potential conflict of interest relevant to this article was reported for other authors. Consent to participate: Informed consent was obtained from all individual participants included in the study or from legal guardians. Consent to publish: The authors and participant has consented to the submission in the journal.

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