Background. Automatic tube compensation (ATC) has been developed to overcome the imposed work of breathing due to artificial airways during spontaneous breathing trials (SBTs). Objectives. This study aimed to assess extubation outcome after an SBT (spontaneous breathing trial) with ATC compared with pressure support ventilation (PSV) and to determine the risk factors for extubation failure. Methods. Patients ready for extubation were randomly assigned to two-hour spontaneous breathing trial with either ATC or pressure support ventilation. Results. In the ATC group ( ), 11 (65%) patients passed the SBT with subsequent extubation failure (9%). While in PSV group ( ), 10 (53%) patients passed the SBT with subsequent extubation failure (10%). This represented a positive predictive value for ATC of 91% and PSV of 90% ( ). Five (83%) of the patients who failed the SBT in ATC group were reintubated. This represented a higher negative predictive value for ATC of 83% than for PSV which was 56%. None of the assessed risk factors were independently associated with extubation failure including failed trial. Conclusion. ATC was equivalent to PSV in predicting patients with successful extubation. A trial failure in ATC group is associated with but does not definitely predict extubation failure. 1. Introduction Prolonged and unnecessary delay in tracheal extubation result in increased complication rates for patients receiving mechanical ventilation including airway trauma, chronic lung disease, ventilator associated pneumonia, and increased hospital costs [1]. On the other hand-premature discontinuation carries a set of problems involving difficulty in establishing airways and compromised blood gas exchange [2]. Different methods, including clinical trials and calculated indices, have been developed to evaluate patients on mechanical ventilation and predict the optimum time to make the weaning decision [3]. These methods include, tolerances of spontaneous breathing trials (SBTs), counting the respiratory rate, observation of work of breathing, and many other calculated indices such as the oxygenation index, measurement of the tidal volume and dynamic compliance, and the commonly used rapid shallow breathing index. However, some of these indices may be misleading, cost-effective, and requiring highly sophisticated equipments [4]. Recently, a tolerance of a spontaneous breathing trial while the patient receives varying levels of ventilatory support including continuous positive airway pressure (CPAP), low-level pressure support ventilation (PSV), or very recently
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