Objective To compare the difference of respiratory mechanics parameters between three different spontaneous breathing trials on COPD patients in weaning process.
Methods 17 patients with COPD underwent mechanical ventilation for at least 48 hours who were stable and ready for weaning were enrolled. All patients underwent three spontaneous breathing trials, ie, automatic tube compensation (ATC,compensation level 100%),low level pressure support ventilation (PSV,7 cm H2O) and T-piece. Each spontaneous breathing trials continued for 10 minutes. Before each autonomous respiration experiment ended,the respiratory mechanics parameters including high airway pressure (PIP),breathing rate (RR),blood oxygen saturation (SaO2),airway occlusion pressure at 0.1 second (P0.1),maximal inspiratory mouth pressure(Pimax) and rapid shallow breathing index (RSBI) were measured. Their differences between three spontaneous breathing trials were compared.
Results 12 patients successfully completed three different methods of spontaneous breathing test. Compared with the T-piece,P0.1,Pimax,RSBI and RR in the COPD patients using low level PSV and ATC were significantly decreased while VT and SaO2 were increased. The difference of each parameter in the low level PSV group and the ATC group had statistical significance compared with T-piece group (P<0.05). Compared with the low PSV group,P0.1,Pimax,RSBI and RR in ATC group were elevated while PIP,VT and SaO2 were reduced. The differences of P0.1,Pimax,RSBI,PIP and RR between two groups were statistically significant (P<0.05).
Conclusion For COPD patients in weaning process with spontaneous breathing trial,both low levels of PSV and ATC are better than T-piece,and the patients are more comfortable with ATC100% than PSV.
Citation：
DuanJunfeng, ChenXiaoju, WangTao, ZhangWenbo, XiangXiaojun. Effects of Different Spontaneous Breathing Trials on Respiratory Mechanics Parameters of COPD Patients. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(1): 10-13. doi: 10.7507/1671-6205.2014003
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Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
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罗彬,朱晓琼.浅快呼吸指数对慢性阻塞性肺疾病患者撤机的意义.吉林医学,2009,30:2255-2256.
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马玉杰,曹相原.浅快呼吸指数的变化趋势在机械通气撤离中的预测价值.中国呼吸与危重监护杂志,2010,9:567-569.
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- 1. Boutou AK,Abatzidou F,Tryfon S,et al.Diagnostic accuracy of the rapid shallow breathing index to predict a successful spontaneous breathing trial outcome in mechanically ventilated patients with chronic obstructive pulmonary disease.Heart Lung,2011,40:105-110.
- 2. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版).中华内科杂志,2007,46:254-261.
- 3. MacIntyre NR,Cook DJ,Ely EW Jr,et al.Evidence-based guidelines for weaning and discontinuing ventilatory support:a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine.Chest,2001,120:375S-395S.
- 4. 陈宇清,陈钦,周新.自动导管阻力补偿技术联合压力支持通气对撤机患者呼吸力学参数的影响.生物医学工程与临床,2009,13:328-331.
- 5. Frutos-Vivar F, Esteban A.When to wean from a ventilator:an evidence-based strategy.Cleve Clin J Med,2003,70:389-340.
- 6. Guttmann J,Haberthür C,Mols G.Automatic tube compensation.Respir Care Clin N Am,2001,7:475-501.
- 7. 俞森洋,罗显荣.呼吸危重病学.北京:中国协和医科大学出版社,2008,470-473.
- 8. Tanios MA,Epstein SK.Spontaneous breathing trials:should we use automatic tube compensation.Respir Care,2010,55:640-642.
- 9. 邓琳,龚鸿昌.机械通气患者的不同撤机方式的研究.四川医学,2011,32:1417-1418.
- 10. Unoki T,Serita A,Grap MJ.Automatic tube compensation during weaning from mechanical ventilation:evidence and clinical implications.Crit Care Nurse,2008,28:34-42.
- 11. Cohen JD,Shapiro M,Grozovski E,et al.Automatic tube compensation-assisted respiratory rate to tidal volume ratio improves the prediction of weaning outcome.Chest,2002,122:980-984.
- 12. Figueroa-Casas JB,Montoya R,Arzabala A,et al.Comparison between automatic tube compensation and continuous positive airway pressure during spontaneous breathing trials.Respir Care,2010,55:549-554.
- 13. 罗彬,朱晓琼.浅快呼吸指数对慢性阻塞性肺疾病患者撤机的意义.吉林医学,2009,30:2255-2256.
- 14. 马玉杰,曹相原.浅快呼吸指数的变化趋势在机械通气撤离中的预测价值.中国呼吸与危重监护杂志,2010,9:567-569.
