• Sandy Nogueira Teixeira, Erica Fernanda Osaku, CostaClaudia Rejane Lima de MacedoCRIntensive Care Unit., Beatriz Fernandes Toccolini, Nicolle Lamberti Costa, Maria Fernanda Cândia, Marcela Aparecida Leite, Amaury Cezar Jorge, and Péricles Almeida Delfino Duarte.
• Intensive Care Unit sandy.fisio@hotmail.com.
• Respir Care. 2015 Nov 1; 60 (11): 1527-35.

BackgroundFailure to wean can prolong ICU stay, increase complications associated with mechanical ventilation, and increase morbidity and mortality. The spontaneous breathing trial (SBT) is one method used to assess weaning. The aim of this study was to assess proportional assist ventilation plus (PAV+) as an SBT by comparing its applicability, safety, and efficacy with T-tube and pressure support ventilation (PSV).MethodsA randomized study was performed involving 160 adult subjects who remained on mechanical ventilation for > 24 h. Subjects were randomly assigned to the PAV+, PSV, or T-tube group. When subjects were ready to perform the SBT, subjects in the PAV+ group were ventilated in PAV+ mode (receiving support of up to 40%), the pressure support was reduced to 7 cm H2O in the PSV group, and subjects in the T-tube group were connected to one T-piece with supplemental oxygen. Subjects were observed for signs of intolerance, whereupon the trial was interrupted. When the trial succeeded, the subjects were extubated and assessed until discharge.ResultsThe subjects were predominantly male (66.5%), and the leading cause of admission was traumatic brain injury. The groups were similar with respect to baseline characteristics, and no significant difference was observed among the groups regarding extubation success or failure. Analysis of the specificity and sensitivity revealed good sensitivity for all groups; however, the PAV+ group had higher specificity (66.6%) and higher sensitivity (97.6%), with prediction of ∼ 92.1% of the success and failure events.ConclusionsNo significant differences in the groups was observed regarding the rate of extubation failure, duration of mechanical ventilation, and ICU and hospital stay, indicating that PAV+ is an alternative for use as an SBT.Copyright © 2015 by Daedalus Enterprises.

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