Comparison Between Automatic Tube Compensation and Continuous Positive Airway Pressure During Spontaneous Breathing Trials

BACKGROUND: Various methods to perform spontaneous breathing trials (SBTs) exist, but no one method has been shown to be superior. Automatic tube compensation (ATC) is a new and potentially advantageous ventilation mode to use during SBT. We compared ATC to continuous positive airway pressure (CPAP) during SBTs, to determine their efficacy in identifying patients ready to be liberated from mechanical ventilation.

METHODS: We randomized 118 adults in a general intensive care unit on mechanical ventilation for ≥ 24 h who were about to undergo an SBT as part of an established respiratory-therapist-driven weaning protocol to undergo 30 min SBT with ATC or CPAP with no pressure support. We predefined the SBT-failure criteria. The primary outcome was duration of weaning (days from first SBT to extubation). Other outcomes included unsuccessful extubation within 48 h, first-SBT-pass rate, and total duration of mechanical ventilation.

RESULTS: We found a trend toward less failure of first SBT with ATC, compared to CPAP (3% vs 13% respectively, P = .09), but no difference in duration of weaning, rate of unsuccessful extubation, or duration of mechanical ventilation.

CONCLUSIONS: When applied as part of a respiratory-therapist-driven weaning protocol in a general intensive-care population, SBTs with ATC were safe but did not hasten liberation from mechanical ventilation, when compared to CPAP.