Comparison of Pressure support ventilation and T-piece ventilation during spontaneous breathing trials on successful extubation among patients on mechanical ventilation.

Delayed weaning can lead to a number of complications like ventilator induced lung injury (VILI), ventilator associated pneumonia (VAP) and ventilator induced diaphragmatic dysfunction. In an intensive care unit, spontaneous breathing trials are routinely conducted to facilitate decision making regarding timely extubation and to reduce the patient’s chance of getting into the above-mentioned unfavorable conditions or invasive ventilation. Daily SBTs are the best approach to determine whether patients are ready for disconnection from mechanical ventilation, but mode and duration remains controversial. Hence in this study, pressure support and T-piece SBTs are compared in providing successful extubation.

 Research question / hypothesis:

Whether a 30-minute Pressure support ventilation as compared to a 2-hour T-piece ventilation has atleast 15% higher rates of successful extubation among adult patients on mechanical ventilation?

 Study procedure:

A. Patients in MICU and emergency ICU who fulfil the inclusion criteria will be recruited to the study.

B. Once the patient is found to satisfy the inclusion criteria, consent will be taken from the patient for recruitment into the study. If the patient cannot give consent, consent will be obtained from his next of kin.

C. Participants will be randomly divided into two arms (T-piece arm and pressure support arm).

D. Detailed history and examination of all the patients will be documented.

E. Patients under both arms will undergo baseline laboratory investigations like chest X-ray, arterial blood gas analysis, complete blood count, renal function tests, liver function test and serum electrolytes.

F. Primary diagnosis will be established for all cases. APACHE II scores will be calculated and recorded.

G. Patients in group A will undergo a 2-hour T-piece SBT.

H. Similarly, Patients in group B will undergo a 30 minutes pressure support SBT with 8 cm H2O pressure.

I. FiO2 will remain unchanged from the mechanical ventilation period leading upto the SBT.

J. During weaning, if any patient fulfils the criteria for weaning failure, they will be considered failure of the particular weaning mode that he is on.

K. Patients who complete the SBT successfully will be extubated and will be observed for the next 72 hours to see if they are capable of sustaining without reintubation or Non-invasive positive pressure ventilation. Patients who required reintubation or NIPPV as decided by the treating clinicians will be considered as weaning failure.