Ventilation & weaning · Weaning from the ventilator
Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece
| Design | Randomised controlled trial |
|---|---|
| Treatment | Spontaneous breathing trial with pressure-support ventilation |
| Control | Spontaneous breathing trial with a T-piece |
| Population | 969 patients at high risk of extubation failure |
| Follow-up | 28 days |
| Primary endpoint | Ventilator-free days at day 28 |
| Result | Median ventilator-free days 27 (IQR 24 to 27) with pressure support versus 27 (IQR 23 to 27) with a T-piece — difference 0 days (95% CI -0.5 to 1, p=0.31). Extubation within 24 hours occurred in 376 of 484 (77.7%) versus 350 of 485 (72.2%). |
| Secondary endpoints | Extubation within 24 hours, reintubation, mortality |
Among patients who had a high risk of extubation failure, spontaneous-breathing trials performed with PSV did not result in significantly more ventilator-free days at day 28 than spontaneous-breathing trials performed with a T-piece.
The trial authors, in the published abstract
A long-running argument settled as a draw. Slightly more patients passed and were extubated promptly with pressure support, but it made no difference to the outcome that matters. Either technique is defensible; departmental habit is as good a reason as any.
Thille AW, Gacouin A, Coudroy R, et al. Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece. N Engl J Med 2022 Nov 17;387(20):1843-1854.