Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure

Objective: We hypothesized that the additional use of automatic tube compensation (ATC) during a spontaneous breathing trial with continuous positive airway pressure (CPAP), by minimizing respiratory work, would result in more patients undergoing successful extubation. Design: Prospective, randomized, controlled study. Setting: A ten-bed, general intensive care department at a tertiary-care hospital. Patients: Adult patients (n = 99) who had undergone mechanical ventilation for >24 hrs and met defined criteria for a weaning trial. Interventions: Patients were randomized to undergo a 1-hr spontaneous breathing trial with either ATC with CPAP (ATC group, n = 51) or CPAP alone (CPAP group, n = 48). ATC was provided by commercially available mechanical ventilators. Patients tolerating the spontaneous breathing trial underwent immediate extubation. The primary outcome measure was successful extubation, defined as the ability to maintain spontaneous breathing for 48 hrs after discontinuation of mechanical ventilation and extubation. Measurements and Main Results: There were no significant differences in demographic, respiratory, or hemodynamic characteristics between the two groups at the start of the spontaneous breathing trial. There was a trend for more patients in the ATC group to tolerate the breathing trial and undergo extubation (96% vs. 85%; p = .08). The rate of reintubation was 14% in the ATC group and 24% in the CPAP group (p = .28). Significantly more patients in the ATC group thus met the criteria for successful extubation (82% vs. 65%; p = 0.04). Conclusion: This is the largest single-center study to date assessing the use of commercially available ATC and suggests that this might be a useful mode for performing a spontaneous breathing trial preceding extubation in a general intensive care population.