Comparative evaluation of spontaneous breathing trial techniques for ventilator weaning: a bench study
Abstract Background Spontaneous breathing trials (SBT) are crucial for determining when mechanically ventilated patients are ready for extubation. While pressure support (PS) and T-piece trials are commonly used, humidified high-flow (HHF) is increasingly considered, but its physiological effects re...
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| Language: | English |
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SpringerOpen
2025-08-01
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| Series: | Intensive Care Medicine Experimental |
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| Online Access: | https://doi.org/10.1186/s40635-025-00788-y |
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| author | Guillaume Fossat Roberto Martínez Alejos Emeline Fresnel Mai-Anh Nay Clément Medrinal Marius Lebret |
| author_facet | Guillaume Fossat Roberto Martínez Alejos Emeline Fresnel Mai-Anh Nay Clément Medrinal Marius Lebret |
| author_sort | Guillaume Fossat |
| collection | DOAJ |
| description | Abstract Background Spontaneous breathing trials (SBT) are crucial for determining when mechanically ventilated patients are ready for extubation. While pressure support (PS) and T-piece trials are commonly used, humidified high-flow (HHF) is increasingly considered, but its physiological effects remain unclear. This bench study compares T-piece, PS, and HHF modalities, evaluating their impact on work of breathing (WOB), tidal volume (Vt), total positive end-expiratory pressure (PEEPtot) and CO2 clearance. Methods A 3D-printed manikin head connected to an artificial lung was used. Four SBT modalities were tested: T-piece with and without supplemental oxygen, PS at 7 cmH2O (PEEP 0 cmH2O), and HHF at 50 L/min. The tests were performed under three lung conditions (normal, obstructive, restrictive) and two respiratory drive and effort settings (normal and intense), resulting in 24 scenarios. Measurements included WOB, CO2 clearance, PEEPtot, and Vt. Results T-piece and HHF50 SBTs exhibited similar effects on WOB, irrespective of the effort pattern associated with the underlying respiratory mechanics. For intense effort patterns, the CO2 concentration was lower with HHF than with PS, regardless of respiratory mechanics. The HHF50 SBT increased PEEPtot more than T-piece SBTs, but less than PS SBT, for all scenarios. HHF50 SBT generated lower tidal volume than T-piece and PS SBTs. Conclusions Humidified high-flow at 50 L/min, while preserving WOB and not increasing tidal volume, may offer specific advantages, such as improved CO2 clearance and PEEP effect, and could be considered as a trade-off for T-piece or PS SBTs. |
| format | Article |
| id | doaj-art-a477e2929cfa4bb39385d02f35f7a1ae |
| institution | Kabale University |
| issn | 2197-425X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj-art-a477e2929cfa4bb39385d02f35f7a1ae2025-08-20T04:01:42ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2025-08-011311710.1186/s40635-025-00788-yComparative evaluation of spontaneous breathing trial techniques for ventilator weaning: a bench studyGuillaume Fossat0Roberto Martínez Alejos1Emeline Fresnel2Mai-Anh Nay3Clément Medrinal4Marius Lebret5Univ Rouen Normandie, GRHVN UR3830, Institute for Research and Innovation in Biomedicine (IRIB)Kernel BiomedicalKernel BiomedicalIntensive Care Unit Department, ORLEANS University HospitalUniv Rouen Normandie, GRHVN UR3830, Institute for Research and Innovation in Biomedicine (IRIB)Kernel BiomedicalAbstract Background Spontaneous breathing trials (SBT) are crucial for determining when mechanically ventilated patients are ready for extubation. While pressure support (PS) and T-piece trials are commonly used, humidified high-flow (HHF) is increasingly considered, but its physiological effects remain unclear. This bench study compares T-piece, PS, and HHF modalities, evaluating their impact on work of breathing (WOB), tidal volume (Vt), total positive end-expiratory pressure (PEEPtot) and CO2 clearance. Methods A 3D-printed manikin head connected to an artificial lung was used. Four SBT modalities were tested: T-piece with and without supplemental oxygen, PS at 7 cmH2O (PEEP 0 cmH2O), and HHF at 50 L/min. The tests were performed under three lung conditions (normal, obstructive, restrictive) and two respiratory drive and effort settings (normal and intense), resulting in 24 scenarios. Measurements included WOB, CO2 clearance, PEEPtot, and Vt. Results T-piece and HHF50 SBTs exhibited similar effects on WOB, irrespective of the effort pattern associated with the underlying respiratory mechanics. For intense effort patterns, the CO2 concentration was lower with HHF than with PS, regardless of respiratory mechanics. The HHF50 SBT increased PEEPtot more than T-piece SBTs, but less than PS SBT, for all scenarios. HHF50 SBT generated lower tidal volume than T-piece and PS SBTs. Conclusions Humidified high-flow at 50 L/min, while preserving WOB and not increasing tidal volume, may offer specific advantages, such as improved CO2 clearance and PEEP effect, and could be considered as a trade-off for T-piece or PS SBTs.https://doi.org/10.1186/s40635-025-00788-ySpontaneous breathing trialHigh flowWeaningWork of breathingDead space washoutICU |
| spellingShingle | Guillaume Fossat Roberto Martínez Alejos Emeline Fresnel Mai-Anh Nay Clément Medrinal Marius Lebret Comparative evaluation of spontaneous breathing trial techniques for ventilator weaning: a bench study Intensive Care Medicine Experimental Spontaneous breathing trial High flow Weaning Work of breathing Dead space washout ICU |
| title | Comparative evaluation of spontaneous breathing trial techniques for ventilator weaning: a bench study |
| title_full | Comparative evaluation of spontaneous breathing trial techniques for ventilator weaning: a bench study |
| title_fullStr | Comparative evaluation of spontaneous breathing trial techniques for ventilator weaning: a bench study |
| title_full_unstemmed | Comparative evaluation of spontaneous breathing trial techniques for ventilator weaning: a bench study |
| title_short | Comparative evaluation of spontaneous breathing trial techniques for ventilator weaning: a bench study |
| title_sort | comparative evaluation of spontaneous breathing trial techniques for ventilator weaning a bench study |
| topic | Spontaneous breathing trial High flow Weaning Work of breathing Dead space washout ICU |
| url | https://doi.org/10.1186/s40635-025-00788-y |
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