To do this, we assessed extubation outcome after a spontaneous breathing trial with ATC and compared it with PSV. It was the aim of the present prospective study to further assess the value of ATC in predicting successful weaning. However, the ventilator used in all these studies was equipped with prototype ATC software, not available in commercial mechanical ventilators. ATC was also perceived to be more comfortable by normal volunteers and resulted in less ineffective ventilator-triggering as a result of auto-positive end expiratory pressure (PEEP). However, studies have shown that compared with PSV, ATC was more effective in overcoming the work of breathing necessary to overcome endotracheal tube resistance. PSV was widely used in the performance of a spontaneous breathing trial and has been shown to compensate for the additional work of breathing imposed by the endotracheal tube. This mode of ventilation thus seems ideally suited for use during the weaning period. It potentially simulates spontaneous breathing without the endotracheal tube, so it has been designated as 'electronic extubation'. It delivers the exact amount of pressure necessary to overcome the resistive load of the endotracheal tube for the flow measured at the time, without affecting the patient's breathing pattern. The magnitude of the response was influenced by the mode used, being significantly greater at the end of a breathing trial with a T-tube than with either PSV or CPAP.Īutomatic tube compensation (ATC) has been developed to overcome the imposed work of breathing due to artificial airways. In support of this, Koksal and colleagues have demonstrated a significant increase in the endocrine stress response during a breathing trial. The level of support may be relevant to whether the breathing trial is tolerated, because it has been argued that, for some patients, weaning failure may be attributable to the respiratory load imposed by the endotracheal tube. These trials have traditionally been performed while the patient receives varying levels of ventilatory support, including, in recent studies, continuous positive airway pressure (CPAP), a T-tube circuit or low-level pressure support ventilation (PSV). Tolerance of a spontaneous breathing trial is an evidence-based strategy to predict successful weaning from mechanical ventilation. Successful weaning and liberation from mechanical ventilation remain critical stages of a patient's intensive care unit (ICU) stay. Finally, the ATC-assisted f/VT was found to have a significant contribution in predicting successful liberation and extubation compared with the non-significant contribution of the unassisted f/VT (unassisted f/VT, p = 0.19 ATC-assisted f/VT, p = 0.005). This represented a positive predictive value for PSV of 0.85 and ATC of 0.80 (p = 0.87). The percentage of patients who remained extubated for more than 48 hours was similar in both groups (ATC = 74.7% vs. The rate of reintubation was not different between the groups (total group = 17.3% ATC = 18.4% vs. In the PSV group, 13 of 93 (14%) patients failed the breathing trial compared with only 6 of 87 (6%) in the ATC group this observed 8% difference, however, did not reach statistical significance (p = 0.12). There were no significant differences in any of the baseline characteristics between the two groups apart from a significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II score in the ATC group (p = 0.009).
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