Automatic Tube Compensation vs. Pressure Support Ventilation During Spontaneous Breathing Trials in Critically Ill Adults: A Cluster-Randomized, Cluster-Crossover Trial
Rush University Medical Center
Summary
For patients requiring mechanical ventilation, spontaneous breathing trials (SBTs) are conducted to determine if it is safe to remove the breathing tube. There are multiple methods for conducting SBTs. The purpose of this study is to compare the effects of 2 methods, pressure support ventilation (PSV) versus automatic tube compensation (ATC), on successful extubation for critically ill adult patients who received mechanical ventilation for over 24 hours.
Description
The delivery of pressure support through the ventilator can be fixed using the pressure support ventilation (PSV) mode or variable using the automatic tube compensation (ATC) mode. Similar to PSV, ATC provides pressure support but dynamically adjusts it to compensate the resistive work of breathing and the mechanical load on respiratory muscles imposed by an artificial airway, such as an endotracheal or tracheostomy tube. Although both ATC and PSV are licensed and used in clinical practice, the optimal method to deliver pressure support during a spontaneous breathing trial (SBT) remains unknow…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Admitted to intensive care unit (ICU) * Age 18 years or older * Requiring invasive mechanical ventilation for at least 24 hours * Pass spontaneous breathing trial screen criteria Exclusion Criteria: * Clinical decision made not to proceed with extubation regardless of spontaneous breathing trial (SBT) results * Do not intubate (DNI) order * Presence of tracheostomy * Pregnancy * Known prisoner * Immediate need for extubation, self-extubation, or unplanned extubation that precludes safe performance of study procedures * Enrolled in another clinical trial that impacts ve…
Interventions
- OtherPressure Support Ventilation (PSV)
Spontaneous breathing trials will be conducted using the mode pressure support ventilation (PSV) with settings of a pressure support of 5 cmH2O and positive end expiratory pressure (PEEP) 5 cmH2O.
- OtherAutomatic tube compensation (ATC)
Spontaneous breathing trials will be conducted using the mode automatic tube compensation (ATC) with settings of 100% tube compensation and a positive end expiratory pressure (PEEP) of 5 cmH2O.
Location
- Rush University Medical CenterChicago, Illinois