A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients

Objective: To compare the percentage of infants and children successfully extubated after a trial of breathing performed with either pressure support or T-piece. Design: Prospective and randomized study. Setting: Three medical-surgical pediatric intensive care units (PICUs). Patients: Two hundred fifty-seven consecutive infants and children who received mechanical ventilation for at least 48 h and were deemed ready to undergo a breathing trial by their primary physician. Interventions: Patients were randomly assigned to undergo a trial of breathing in one of two ways: pressure support of 10 cmH(2)O or T-piece. Bedside measurements of respiratory function were obtained immediately before discontinuation of mechanical ventilation and within the first 5 min of breathing through a T-piece. The primary physicians were unaware of those measurements, and the decision to extubate a patient at the end of the breathing trial was made by them. Measurements and main results: Of the 125 patients in the pressure support group, 99 (79.2 %) completed the breathing trial and were extubated, but 15 of them (15.1 %) required reintubation within 48 h. Of the 132 patients in the T-piece group, 102 (77.5 %) completed the breathing trial and were extubated, but 13 of them (12.7 %) required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after the breathing trial did not differ in the pressure support and T-piece groups (67.2 % versus 67.4 %, p = 0.97). Conclusions: In infants and children mechanically ventilated, successful extubation was achieved equally effectively after a first breathing trial performed with pressure support of 10 cmH(2)O or a T-piece.