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Byline: Andreas Perren (1), Guido Domenighetti (2), Simonetta Mauri (2), Franco Genini (2), Nicoletta Vizzardi (1) Keywords: Weaning Clinical outcome Pressure support ventilation Duration of weaning trial Extubation Adults Abstract: Abstract Objective. To investigate the possibility of successful extubation performing a spontaneous breathing trial (SBT) in pressure support ventilation (PSV) with target durations of 30 and 120 min. Design and setting. Prospective and randomized study in two medical-surgical adult intensive care units. Patients and participants. 98 adult patients supported by mechanical ventilation for at least 48 h and considered ready for a weaning trial. Interventions. An SBT conducted in PSV with 7 cm[H.sub.2]O and patients randomly assigned to two groups with target durations of 30- and 120-min. Measurements and results. In the 30-min group 43 patients (93%) tolerated the SBT and were extubated while 4 (9%) needed reintubation within 48 h in the 120-min group 46 patients (88%) successfully completed the trial and were extubated while 2 (4%) were reintubated. ICU mortality in the groups with short and long periods was 6% and 4%, and in-hospital mortality 20% and 17%, respectively. Those successful in the 30- and 120-min groups had similar length of ICU stay (6 and 7 days, respectively) and in-hospital length of stay (20 and 25 days, respectively). Compared to the successfully extubated, the reintubated patients had significantly higher length of ICU stay and mortality (17 vs. 6 days and 33 vs. 3.6%, respectively). Conclusions. An SBT with PSV of 7 cm[H.sub.2]O lasting 30 min is equally effective in recognizing the successfully extubated patients as a 120-min trial. Author Affiliation: (1) Centro Cure Intense, Ospedale Regionale Bellinzona e Valli, 6500 Bellinzona, Switzerland (2) Cure Intense, Ospedale Regionale La Carita, 6600 Locarno, Switzerland Article History: Received Date: 04/01/2002 Accepted Date: 29/04/2002 Article note: Electronic Publication

Byline: B. Schonhofer (1), S. Euteneuer (1), S. Nava (2), S. Suchi (1), D. Kohler (1) Keywords: Difficult weaning from respirator Outcome Survival Mortality Abstract: Abstract Objective. Hospital mortality and survival rates of long-term ventilated patients. Design. Retrospective cohort study. Setting. Specialised national weaning centre. Intervention. Protocol-directed liberation from ventilator. Patients. Four hundred three of 640 patients with prolonged mechanical ventilation (MV) who were admitted to our respiratory intensive care unit (RICU) were studied. MV lasted longer than 2 weeks and patients had failed more than two weaning trials in the referring ICUs. The majority of patients (59.3%) had chronic obstructive pulmonary disease (COPD). Results. After a mean duration of 41 days of MV prior to transfer, 68% of patients were liberated from the ventilator. In total, 98 of 403 patients (24.3%) died during the stay in our hospital, 305 patients (75.7%) were discharged. Compared to the non-survivors, the survivors were characterised by younger age, longer length of stay in our RICU, lower severity of illness scores at admission, fewer cardiac illnesses and a higher rate of weaning success. In 31.5% of the discharged patients non-invasive MV (NIV) was initiated during the stay at our unit. We gathered follow-up data on 293 patients (96.1%). Post-discharge survival rates were 67.6% at 3 months, 49.4% at 1 year and 38.1% at 3 years. Length of survival was significantly dependent on age, weaning success and main diagnosis (i.e., prognosis in COPD is worse compared to thoracic restriction, neuromuscular disease and others) in the multivariate analysis. Conclusions. Difficult-to-wean patients have a high hospital mortality rate and poor long-term prognosis. Age, main diagnosis, severity of illness, weaning success and institution of NIV predict survival. Author Affiliation: (1) Krankenhaus Kloster Grafschaft (KKG), Zentrum fur Pneumologie, Beatmungs- und Schlafmedizin, 57392 Schmallenberg, Germany (2) Respiratory Intensive Care Unit, Fondazione S. Maugeri, Istituto Scientifico di Pavia, Via Ferrata 8, 100 Pavia, Italy (3) Address for correspondence: Division of Pulmonary and Critical Care Medicine, Edward Hines Jr., VA Hospital and Loyola University of Chicago, 5th & Roosevelt Road, Building 1, Room E 438, RTE. 111 N, Chicago, Hines, IL 60141, USA Article History: Received Date: 16/07/2001 Accepted Date: 11/03/2002 Article note: Electronic Publication