Automatic tube compensation versus pressure support ventilation as a weaning mode: does it make a difference?

Abstract

Background: Automatic tube compensation (ATC) is one of the newer weaning modes that seem promising to improve the weaning process. Objective: To evaluate the benefit of ATC in hastening and improving the weaning process. Patients and methods: In a prospective randomized-controlled trial, all eligible patients of Assiut Chest Department who were mechanically ventilated were included during the period from April 2010 to March 2012. They were divided into two groups, 88 patients weaned by pressure support ventilation (PSV) and 78 patients weaned by ATC. The primary outcomes measure was the ability to maintain spontaneous breathing for more than 48 h after extubation and weaning duration. Results: A total of 166 patients were included; the mean age was 58.6 ± 12.3 years; males represented 70%. The weaning duration was shorter in ATC than in PSV (19.7 vs. 29.9 h, respectively). Also, ATC had a higher trend toward successful extubation than PSV (88.5 vs. 78.4%). Patients who underwent weaning by ATC had a nonsignificant trend toward simple weaning. Moreover, hospital mortality was less in ATC (ATC 15.4% vs. PSV 22.7%). However, the difference did not reach significance in all primary and secondary outcomes. Conclusion: In respiratory ICU patients, the weaning process can be usefully performed by ATC (at least as effective as PSV) but without significant hastening of the weaning process. All primary and secondary outcomes were potentially improved (weaning duration, extubation outcome, predictive value of ATC-assisted ratio of respiratory rate and tidal volume, number of spontaneous breathing trials, weaning category, reintubation rate, complications, and hospital mortality).