• Rémi Coudroy, Alice Lejars, Maeva Rodriguez, Jean-Pierre Frat, Christophe Rault, François Arrivé, Sylvain Le Pape, and Arnaud W Thille.
• CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France; INSERM CIC 1402, IS-ALIVE Research Group, Université de Poitiers, Poitiers, France. Electronic address: r.coudroy@yahoo.fr.
• Chest. 2024 Jan 29.

BackgroundReconnection to the ventilator for 1 h following a successful spontaneous breathing trial (SBT) may reduce reintubation rates compared with direct extubation. However, the physiologic mechanisms leading to this effect are unclear.Research QuestionDoes reconnection to the ventilator for 1 h reverse alveolar derecruitment induced by SBT, and is alveolar derecruitment more pronounced with a T-piece than with pressure-support ventilation (PSV)?Study Design And MethodsThis is an ancillary study of a randomized clinical trial comparing SBT performed with a T-piece or with PSV. Alveolar recruitment was assessed by using measurement of end-expiratory lung volume (EELV).ResultsOf the 25 patients analyzed following successful SBT, 11 underwent SBT with a T-piece and 14 with PSV. At the end of the SBT, EELV decreased by -30% (95% CI, -37 to -23) compared with baseline prior to the SBT. This reduction was greater with a T-piece than with PSV: -43% (95% CI, -51 to -35) vs -20% (95% CI, -26 to -13); P < .001. Following reconnection to the ventilator for 1 h, EELV accounted for 96% (95% CI, 92 to 101) of baseline EELV and did not significantly differ from prior to the SBT (P = .104). Following 10 min of reconnection to the ventilator, EELV wasted at the end of the SBT was completely recovered using PSV (P = .574), whereas it remained lower than prior to the SBT using a T-piece (P = .010).InterpretationSignificant alveolar derecruitment was observed at the end of an SBT and was markedly more pronounced with a T-piece than with PSV. Reconnection to the ventilator for 1 h allowed complete recovery of alveolar derecruitment.Clinical Trial RegistrationClinicalTrials.gov; No.: NCT04227639; URL: www.Clinicaltrialsgov.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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