Pressure support vs unassisted breathing through a tracheostomy collar on weaning duration
Jubran 2013 trial design and results
Design
Randomised trial
Treatment
Unassisted breathing through a tracheostomy collar
Control
Pressure support ventilation
Population
312 patients requiring prolonged mechanical ventilation, transferred to a long-term care facility
Follow-up
6 months
Primary endpoint
Weaning duration
Result
Weaning was achieved in 85 of 160 (53.1%) with tracheostomy collar and 68 of 152 (44.7%) with pressure support; deaths were 16 (10.0%) and 22 (14.5%). Median weaning time was shorter with the tracheostomy collar, 15 days (IQR 8 to 25) versus 19 days (IQR 12 to 31), p=0.004. Adjusted hazard ratio for successful weaning 1.43 (95% CI 1.03 to 1.98, p=0.033).
Secondary endpoints
Mortality at 6 and 12 months, weaning success
Among patients requiring prolonged mechanical ventilation and treated at a single long-term care facility, unassisted breathing through a tracheostomy, compared with pressure support, resulted in shorter median weaning time, although weaning mode had no effect on survival at 6 and 12 months.
The trial authors, in the published abstract
How it has aged
In prolonged ventilation, unloading the respiratory muscles appears to slow recovery rather than help it — the opposite of the intuition behind pressure support. Note this is the prolonged-weaning population, not the routine ICU patient of TIP-EX, where the two techniques tied.
Publications
Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation: a randomized trial
Jubran A, Grant BJ, Duffner LA, et al. Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation: a randomized trial. JAMA 2013 Feb 20;309(7):671-7.
Median weaning time 15 versus 19 days, favouring the tracheostomy collar
Higher rate of successful weaning after adjustment