Ensayo de respiración espontánea en pacientes con enfermedad pulmonar obstructiva crónica: presión positiva continua de la vía aérea (CPAP) versus Tubo en T

Objective: To determine if the spontaneous breathing trial (SBT) with continuous positive airway pressure (CPAP) is superior to SBT with a T-piece in patients with Chronic Obstructive Pulmonary Disease (COPD). Design: A blind clinical test with random distribution. Setting: Three medical-surgical intensive care units. Patients: A random sample of 50 patients with COPD who had received mechanical ventilation for more than 48 hours and who were considered to fulfill weaning criteria: resolution of the exacerbation of the COPD disease, Glasgow scale &gt10, temperature ≤38°C, PaO₂ /FiO₂ quotient &gt150 with an external PEEP ≤5cm H₂O and FiO₂ ≤ to 50%, hemoglobin >10g/dl, no need for vasoactive drugs (except for dopamine ≤ 5γg/kg/min or dobutamine ≤5γg/kg/min) or for sedative agents and effective cough. Intervention: A 30-minute spontaneous respiration trial with T-piece system or CPAP. Variables: Successful weaning from mechanical ventilation, successful SBT, reintubation and intrinsic PEEP. Results: Out of 25 patients who were assigned to the T-tube group, 18 successfully completed the trial and were extubated; 3 of them requiring reintubation. Out of 25 patients who were assigned to the CPAP group, 19 were extubated and none of them required reintubation. There was successful weaning from mechanical ventilation in 76% in SBT-CPAP vs 60% in SBT-TT (relative risk 1.27; 95% confidence interval 0.86 to 1.87). Conclusion: In a COPD patient cohort, the performance of spontaneous breathing with CPAP showed a tendency to better outcome than with T-Piece, however, further research is needed.