tag:blogger.com,1999:blog-7423880838207203660.post8153430661085695672..comments2024-01-10T09:56:49.324-05:00Comments on Respiratory Therapy Cave: Myth buster: Ventilator weaning should be done on minimal settings (no t-piece)Rick Freahttp://www.blogger.com/profile/01132949384071592216noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-7423880838207203660.post-37991880760247938502013-10-03T15:20:08.095-04:002013-10-03T15:20:08.095-04:00we had always preferred t-piece trials over low su...we had always preferred t-piece trials over low support trials for our SBT's. this was to identify a relatively small population of patients with cardiomyopathies and severe COPD that may do just fine with even small levels of peep. during a time of poor staffing we started doing our trials (zeep with no PS)through the ventilator in order to take advantage of the montioring and alarms available and reduce the time needed for setting up the equipment needed for a tpiece trial. zeep with no PS remains our standard for our daily SBT's although who would argue with tobin's preference for tpiece trials as they are most likely the best way to perform them. he is troy whitacre. university of mo. healthcarenoreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-89249238341518420632013-10-03T09:09:13.026-04:002013-10-03T09:09:13.026-04:00Rick,
First, Thank you very much for the mention....Rick,<br /><br />First, Thank you very much for the mention. <br /><br />Second, I agree with you on not just throwing everyone on a 'T-Piece' when you can accomplish the same thing with a "ZEEP(Zero End-Expiratory Pressure)trial" with the ventilator.<br /><br />Third, you mention there is lack of evidence in these trials, yes published evidence which is easy to obtain. Conversely, a abstract was presented this year at the ATS on this topic.<br /><br />The University of Missouri (Columbia) Respiratory Department has been performing ZEEP trials for a number of years. At the ATS conference they presented 6 years of data, showing how ZEEP decreased their reintubation rates by 4% compared to a standard SBT with Pressure support & PEEP. <br /><br />The ZEEP trial exposes the patients that are likely to be false positives (De-compensated CHF & severe COPD) on minimal ventilator settings. K. Scott Richeyhttps://www.blogger.com/profile/05478522157370156562noreply@blogger.com