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ReplyCorrespondence

Comparison of Proportional Assist Ventilation plus, T-Tube Ventilation, and Pressure Support Ventilation as Spontaneous Breathing Trials for Extubation: A Randomized Study–Reply

Erica F Osaku, Cláudia RLM Costa, Sandy N Teixeira and Péricles AD Duarte
Respiratory Care July 2016, 61 (7) 999; DOI: https://doi.org/10.4187/respcare.04890
Erica F Osaku
Intensive Care Unit Western Paraná State University Hospital Cascavel, Paraná, Brazil
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Cláudia RLM Costa
Intensive Care Unit Western Paraná State University Hospital Cascavel, Paraná, Brazil
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Sandy N Teixeira
Intensive Care Unit Western Paraná State University Hospital Cascavel, Paraná, Brazil
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Péricles AD Duarte
Intensive Care Unit Western Paraná State University Hospital Cascavel, Paraná, Brazil
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In reply:

We appreciated the comments from Mathews et al regarding our article in Respiratory Care.1 We would like to add some comments and clarify some issues about their opinions.

The study was randomized (as described in the methods section), and because of its characteristics, it could not be blinded. Therefore, the small differences between the groups were a result of randomization. However, the number of subjects included was enough to answer the main question and achieve our conclusions.

In the cited article, table 11 shows that the distribution of the subjects was broad, including neurological (trauma or non-trauma), medical, and surgical patients. The proposed classification by Mathews et al for “neurologic and non-neurologic” diseases sounds artificial, since it does not consider important clinical situations (such as COPD) and the fact that the neurological population can include young patients with traumatic brain injury and elderly patients with stroke.

According to the study protocol (see methods section), all subjects with COPD were placed on noninvasive ventilation immediately after extubation. This approach is reasonably well described in the literature.2–4 The 15% extubation rate is in line with the international literature.5 We should not compare oranges with apples: In Esteban et al6 the failure rate was 25% of the total number of subjects, which is comparable with that found in our study.

The statistical analysis shows that all methods had comparable abilities to predict extubation success or failure, with values comparable with those in the literature.7,8 The fact that the incidence of tracheostomy was larger in a group does not mean greater efficiency in predicting extubation failure or success: The decision to perform tracheotomy includes several issues, like consciousness level, underlying medical conditions, and etiology of respiratory failure.9

Therefore, Mathews et al share our conclusions, that proportional assist ventilation plus is a safe method and is efficient to perform a spontaneous breathing trial, comparable with other existing methods (T-tube and pressure support ventilation), and a clinical option for clinicians and respiratory practitioners in the ICU.

Footnotes

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2016 by Daedalus Enterprises

References

  1. 1.↵
    1. Teixeira SN,
    2. Osaku EF,
    3. Lima de Macedo Costa CR,
    4. Toccolini BF,
    5. Costa NL,
    6. Cândia MF,
    7. et al
    . Comparison of proportional assist ventilation plus, T-tube ventilation, and pressure support ventilation as spontaneous breathing trials for extubation: a randomized study. Respir Care 2015;60(11):1527–1535.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Truwit JD,
    2. Bernard GR
    . Noninvasive ventilation: don't push too hard. N Engl J Med 2004;350(24):2512–2515.
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    1. Burns KEA,
    2. Adhikari NKJ,
    3. Keenan SP,
    4. Meade M
    . Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review. BMJ 2009;338:b1574.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Hess DR
    . Noninvasive ventilation for acute respiratory failure. Respir Care 2013;58(6):950–972.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Miu T,
    2. Joffe AM,
    3. Yanez ND,
    4. Khandelwal N,
    5. Dagal AHC,
    6. Deem S,
    7. Treggiari MM
    . Predictors of reintubation in critically ill patients. Respir Care 2014;59(2):178–185.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Esteban A,
    2. Frutos-Vivar F,
    3. Ferguson ND,
    4. Arabi Y,
    5. Apezteguía C,
    6. González M,
    7. et al
    . Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004;350(24):2452–2460.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Esteban A,
    2. Alía I,
    3. Gordo F,
    4. Fernández R,
    5. Solsona JF,
    6. Vallverdú I,
    7. et al
    . Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med 1997;156(2):459–465.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Ladeira MT,
    2. Vital FMR,
    3. Andriolo RB,
    4. Andriolo BNG,
    5. Atallah ÁN,
    6. Peccin MS
    . Pressure support versus T-tube for weaning from mechanical ventilation in adults. Cochrane Database Syst Rev 2014;(5):CD006056.
  9. 9.↵
    1. Cheung NH,
    2. Napolitano LM
    . Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care 2014;59(6):895–915; discussion 916-919.
    OpenUrlAbstract/FREE Full Text
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Respiratory Care: 61 (7)
Respiratory Care
Vol. 61, Issue 7
1 Jul 2016
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Comparison of Proportional Assist Ventilation plus, T-Tube Ventilation, and Pressure Support Ventilation as Spontaneous Breathing Trials for Extubation: A Randomized Study–Reply
Erica F Osaku, Cláudia RLM Costa, Sandy N Teixeira, Péricles AD Duarte
Respiratory Care Jul 2016, 61 (7) 999; DOI: 10.4187/respcare.04890

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Comparison of Proportional Assist Ventilation plus, T-Tube Ventilation, and Pressure Support Ventilation as Spontaneous Breathing Trials for Extubation: A Randomized Study–Reply
Erica F Osaku, Cláudia RLM Costa, Sandy N Teixeira, Péricles AD Duarte
Respiratory Care Jul 2016, 61 (7) 999; DOI: 10.4187/respcare.04890
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