Document Detail


Physiological responses during a T-piece weaning trial with a deflated tube.
MedLine Citation:
PMID:  16773334     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: T-piece trials and spontaneous breathing trials through the tracheostomy tube are often used as weaning techniques. They are usually performed with the cuff inflated, which may increase the inspiratory load and/or influence the tidal volume generated by the patient. We assessed diaphragmatic effort during T-piece trials with or without cuff inflation. SETTINGS: Respiratory intensive care unit METHODS: We measured breathing pattern, transdiaphragmatic pressure (Pdi), the pressure-time product of the diaphragm, per minute (PTPdi/min) and per breath (PTPdi/b), and lung mechanics (lung compliance and resistance) in 13 tracheotomized patients ready for a weaning trial. V(T) was recorded with respiratory inductive plethysmography (RIP-V(T)) or pneumotachography PT-V(T)). Patients completed two T-piece trials of 30[Symbol: see text]min each with or without the cuff inflated. RESULTS: RIP-V(T) and PT-V(T) values were similar with the cuff inflated, but PT-V(T) significantly underestimated RIP-V(T) when the cuff was deflated, and therefore the RIP-V(T) was chosen as the reference method. The RIP-V(T) was significantly greater and the Pdi and PTPdi/min significantly lower when the cuff was deflated than when it was inflated. The efficiency of the diaphragm, calculated by the ratio of PTPdi/b over RIP-V(T), was also improved, while no changes were observed in lung mechanics. CONCLUSIONS: Diaphragmatic effort is significantly lower during a T-piece trial with a deflated cuff than when the cuff is inflated, while RIP-V(T) is higher, so that the diaphragm's efficiency in generating tidal volume is also improved.
Authors:
Piero Ceriana; Annalisa Carlucci; Paolo Navalesi; Georgios Prinianakis; Francesco Fanfulla; Monica Delmastro; Stefano Nava
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Publication Detail:
Type:  Journal Article     Date:  2006-06-14
Journal Detail:
Title:  Intensive care medicine     Volume:  32     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-08-22     Completed Date:  2007-02-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1399-403     Citation Subset:  IM    
Affiliation:
Respiratory Intensive Care Unit, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Pavia, Via Ferrata 8, 27100 Pavia, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Plethysmography
Respiratory Mechanics*
Statistics, Nonparametric
Tracheostomy
Ventilator Weaning / instrumentation,  methods*
Work of Breathing*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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