• J A Farias, A Retta, I Alía, F Olazarri, A Esteban, A Golubicki, D Allende, O Maliarchuk, C Peltzer, M E Ratto, R Zalazar, M Garea, and E G Moreno.
• Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, 1425 Buenos Aires, Argentina. jufarias@intramed.net.ar
• Intensive Care Med. 2001 Oct 1;27(10):1649-54.

ObjectiveTo compare the percentage of infants and children successfully extubated after a trial of breathing performed with either pressure support or T-piece.DesignProspective and randomized study.SettingThree medical-surgical pediatric intensive care units (PICUs).PatientsTwo hundred fifty-seven consecutive infants and children who received mechanical ventilation for at least 48 h and were deemed ready to undergo a breathing trial by their primary physician.InterventionsPatients were randomly assigned to undergo a trial of breathing in one of two ways: pressure support of 10 cmH2O or T-piece. Bedside measurements of respiratory function were obtained immediately before discontinuation of mechanical ventilation and within the first 5 min of breathing through a T-piece. The primary physicians were unaware of those measurements, and the decision to extubate a patient at the end of the breathing trial was made by them.Measurements And Main ResultsOf the 125 patients in the pressure support group, 99 (79.2%) completed the breathing trial and were extubated, but 15 of them (15.1%) required reintubation within 48 h. Of the 132 patients in the T-piece group, 102 (77.5%) completed the breathing trial and were extubated, but 13 of them (12.7%) required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after the breathing trial did not differ in the pressure support and T-piece groups (67.2% versus 67.4%, p=0.97).ConclusionsIn infants and children mechanically ventilated, successful extubation was achieved equally effectively after a first breathing trial performed with pressure support of 10 cmH2O or a T-piece.

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