Ventilation & weaning · Weaning from the ventilator
Comparison of three methods of gradual withdrawal from ventilatory support
| Design | Randomised trial in three intensive care units |
|---|---|
| Treatment | Pressure support ventilation weaning |
| Control | T-piece trials, or synchronised intermittent mandatory ventilation |
| Population | 109 of 456 mechanically ventilated patients who met weaning criteria but could not sustain 2 hours of spontaneous breathing |
| Follow-up | 21 days |
| Primary endpoint | Failure to separate from the ventilator by day 21 |
| Result | Considering all causes of weaning failure, failures were fewer with pressure support: 23% versus 43% with T-piece and 42% with synchronised intermittent mandatory ventilation (p=0.05). Excluding patients whose weaning stopped for reasons unrelated to weaning, the difference widened to 8% versus 33% and 39% (p<0.025). |
| Secondary endpoints | Duration of weaning, reintubation within 48 hours |
When all causes for weaning failure were considered, a lower number of failures was found with PSV than with the other two modes, with the difference just reaching the level of significance (23% for PSV, 43% for T piece, 42% for SIMV; p = 0.05).
The trial authors, in the published abstract
Historically important for killing SIMV as a weaning mode, though its pressure-support-versus-T-piece finding has not held up: TIP-EX found them equivalent for the breathing trial, and Jubran 2013 found unassisted breathing better in prolonged weaning. Note the primary result sat exactly at p=0.05.
Brochard L, Rauss A, Benito S, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994 Oct;150(4):896-903.