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Carbon dioxide production and ventilatory inefficiency along a T-piece spontaneous breathing trial are associated with difficult weaning

Introduction: Ventilatory monitoring along a T-piece spontaneous breathing trial (SBT) is limited. Volumetric capnography (VC) provides variables that may be associated with difficult weaning, such as CO2 production (VCO2) and ventilatory inefficiency calculated from the slope between minute ventilation and VCO2 (VE/VCO2). We recently reported a good correlation between VE/VCO2 and physiological dead space in mechanically ventilated patients. Objective: To evaluate if VCO2 and/or VE/VCO2 along a T-piece SBT are associated with difficult weaning. Method: We prospectively performed a one-hour SBT with a CO2/flow sensor between the endotracheal tube and the T-piece. Data was continuously recorded on a personal computer connected to a VC monitor (NICO2, Wallinford, CT, USA). Mean VCO2 and VE/VCO2 slopes were calculated. Difficult weaning included 3 categories: SBT failure (SBT-F) defined as inability to complete the trial or to extubate upon its completion, post extubation respiratory failure (PERF) defined as the need of non-invasive ventilation within 48 hours after extubation and extubation failure (EF) defined as the need for reintubation within 48 hours after extubation. Associations between VC variables and weaning outcomes were explored with t-test and ROC curves. Abstract 4.