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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Background and aim&#58; Studies on weaning strategies have yielded conflicting results regarding the superiority of different methods&#46; The aim of this RCT was to compare the efficacy of gradual pressure support &#40;PS&#41; reduction without an initial spontaneous breathing trial &#40;SBT&#41; with PS-supported SBT&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients mechanically ventilated for &#62;24<span class="elsevierStyleHsp" style=""></span>h were randomized to weaning by gradual reduction of PS without an initial SBT versus once daily SBT &#40;PS 7<span class="elsevierStyleHsp" style=""></span>cm H2O&#41;&#46; The primary outcomes were the rates of successful weaning trial and time to successful extubation&#46; The secondary outcomes were the ICU and hospital length of stay&#44; hospital mortality and the occurrence of ventilator-associated pneumonia &#40;VAP&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 120 patients &#40;61 males&#44; median age 35 years&#41;&#44; 58 were assigned to PS and 62 to the SBT group&#46; The median &#40;IQR&#41; duration of ventilation prior to weaning was 80&#46;2 &#40;50&#46;5---175&#46;6&#41; h&#46; The baseline characteristics were similar in the two groups except the PaO2&#47;FiO2 ratio&#44; which was significantly higher in SBT group&#46; The rates of successful weaning trial &#40;89&#46;7&#37; versus 69&#46;4&#37;&#41; were significantly higher in the PS group&#46; The median duration of weaning &#40;66<span class="elsevierStyleHsp" style=""></span>h versus 81&#46;5<span class="elsevierStyleHsp" style=""></span>h&#44; P &#61; 0&#46;05&#41; and the median duration of ICU stay &#40;8 days versus 9&#46;4 days&#44; P &#61; 0&#46;027&#41; were lower in the PS group&#46; There was no difference in hospital stay&#44; mortality rates or occur-rence of VAP in the two arms&#46; On multivariate analysis&#44; the duration of ventilation prior to weaning&#44; baseline SOFA score and the weaning method were predictors of successful extubation&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Gradual reduction of PS without an initial SBT was found to be associated with better outcomes compared to once daily PS-supported SBT&#46;</p>"
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        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Antecedentes e objetivo&#58; Os estudos sobre estrat&#233;gias de desmame tiveram resultados contro-versos em rela&#231;&#227;o &#224; superioridade de m&#233;todos diferentes&#46; O objetivo deste RCT foi comparar a efic&#225;cia da redu&#231;&#227;o gradual da press&#227;o de suporte &#40;PS&#41; sem uma prova de respira&#231;&#227;o espont&#226;nea &#40;SBT&#41; inicial com a PS apoiada pela SBT&#46; M&#233;todos&#58; Os pacientes ventilados mecanicamente por &#62;24 horas foram aleatorizados para des-mame por redu&#231;&#227;o gradual da PS sem uma SBT inicial versus a SBT uma vez por dia &#40;PS-7<span class="elsevierStyleHsp" style=""></span>cm H2O&#41;&#46; Os principais resultados foram as taxas de sucesso do teste de desmame e o tempo at&#233; a extuba&#231;&#227;o bem sucedida&#46; Os resultados secund&#225;rios foram o tempo em que estiveram na UCI e no hospital&#44; mortalidade hospitalar e ocorr&#234;ncia de pneumonia associada ao ventilador &#40;VAP&#41;&#46; Resultados&#58; Dos 120 pacientes &#40;61 homens&#44; m&#233;dia de idade de 35 anos&#41;&#44; 58 foram atribu&#237;dos ao grupo de PS e 62 ao grupo de SBT&#46; A dura&#231;&#227;o m&#233;dia &#40;IQR&#41; da ventila&#231;&#227;o antes do desmame foi de 80&#44;2 &#40;50&#44;5---175&#44;6&#41; horas&#46; Os par&#226;metros basais foram semelhantes nos dois grupos&#44; exceto a taxa PaO2&#47;FiO2&#44; que foi significativamente superior no grupo de SBT&#46; As taxas de testes de desmame bem-sucedido &#40;89&#44;7&#37; versus 69&#44;4&#37;&#41; foram significativamente superiores no grupo de PS&#46; A dura&#231;&#227;o m&#233;dia de desmame &#40;66 versus 81&#44;5 horas&#44; p &#61; 0&#46;05&#41; e a dura&#231;&#227;o m&#233;dia de tempo na UCI &#40;8 versus 9&#44;4 dias&#44; p &#61; 0&#44;027&#41; foi inferior no grupo PS&#46; N&#227;o se registaram diferen&#231;as no tempo em que estiveram no hospital&#44; taxas de mortalidade ou ocorr&#234;ncia de VAP nos dois grupos&#46; Numa an&#225;lise multivariada&#44; a dura&#231;&#227;o de ventila&#231;&#227;o antes do desmame&#44; o &#237;ndice SOFA basal e o m&#233;todo de desmame foram preditores de uma extuba&#231;&#227;o bem sucedida&#46; Conclus&#245;es&#58; Descobriu-se que a redu&#231;&#227;o gradual da PS sem uma SBT inicial estava associada com melhores resultados comparados com PS apoiada pela SBT uma vez por dia&#46;</p>"
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Original article
Weaning by gradual pressure support (PS) reduction without an initial spontaneous breathing trial (SBT) versus PS-supported SBT: A pilot study
Desmame por redução gradual da pressão de suporte (PS) sem uma prova de respiração espontânea (SBT) inicial versus PS apoiada pela SBT: um estudo piloto
K. Gnanapandithana, R. Agarwalb,
Corresponding author
riteshpgi@gmail.com

Corresponding author.
, A.N. Aggarwalb, D. Guptab
a Dept of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
b Dept of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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    "titulo" => "Weaning by gradual pressure support &#40;PS&#41; reduction without an initial spontaneous breathing trial &#40;SBT&#41; versus PS-supported SBT&#58; A pilot study"
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        "titulo" => "Desmame por redu&#231;&#227;o gradual da press&#227;o de suporte &#40;PS&#41; sem uma prova de respira&#231;&#227;o espont&#226;nea &#40;SBT&#41; inicial versus PS apoiada pela SBT&#58; um estudo piloto"
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            0 => "Mechanical ventilation"
            1 => "Weaning"
            2 => "Extubation"
            3 => "Respiratory failure"
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            0 => "Ventila&#231;&#227;o mec&#226;nica"
            1 => "Desmame"
            2 => "Extuba&#231;&#227;o"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Background and aim&#58; Studies on weaning strategies have yielded conflicting results regarding the superiority of different methods&#46; The aim of this RCT was to compare the efficacy of gradual pressure support &#40;PS&#41; reduction without an initial spontaneous breathing trial &#40;SBT&#41; with PS-supported SBT&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients mechanically ventilated for &#62;24<span class="elsevierStyleHsp" style=""></span>h were randomized to weaning by gradual reduction of PS without an initial SBT versus once daily SBT &#40;PS 7<span class="elsevierStyleHsp" style=""></span>cm H2O&#41;&#46; The primary outcomes were the rates of successful weaning trial and time to successful extubation&#46; The secondary outcomes were the ICU and hospital length of stay&#44; hospital mortality and the occurrence of ventilator-associated pneumonia &#40;VAP&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 120 patients &#40;61 males&#44; median age 35 years&#41;&#44; 58 were assigned to PS and 62 to the SBT group&#46; The median &#40;IQR&#41; duration of ventilation prior to weaning was 80&#46;2 &#40;50&#46;5---175&#46;6&#41; h&#46; The baseline characteristics were similar in the two groups except the PaO2&#47;FiO2 ratio&#44; which was significantly higher in SBT group&#46; The rates of successful weaning trial &#40;89&#46;7&#37; versus 69&#46;4&#37;&#41; were significantly higher in the PS group&#46; The median duration of weaning &#40;66<span class="elsevierStyleHsp" style=""></span>h versus 81&#46;5<span class="elsevierStyleHsp" style=""></span>h&#44; P &#61; 0&#46;05&#41; and the median duration of ICU stay &#40;8 days versus 9&#46;4 days&#44; P &#61; 0&#46;027&#41; were lower in the PS group&#46; There was no difference in hospital stay&#44; mortality rates or occur-rence of VAP in the two arms&#46; On multivariate analysis&#44; the duration of ventilation prior to weaning&#44; baseline SOFA score and the weaning method were predictors of successful extubation&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Gradual reduction of PS without an initial SBT was found to be associated with better outcomes compared to once daily PS-supported SBT&#46;</p>"
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        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Antecedentes e objetivo&#58; Os estudos sobre estrat&#233;gias de desmame tiveram resultados contro-versos em rela&#231;&#227;o &#224; superioridade de m&#233;todos diferentes&#46; O objetivo deste RCT foi comparar a efic&#225;cia da redu&#231;&#227;o gradual da press&#227;o de suporte &#40;PS&#41; sem uma prova de respira&#231;&#227;o espont&#226;nea &#40;SBT&#41; inicial com a PS apoiada pela SBT&#46; M&#233;todos&#58; Os pacientes ventilados mecanicamente por &#62;24 horas foram aleatorizados para des-mame por redu&#231;&#227;o gradual da PS sem uma SBT inicial versus a SBT uma vez por dia &#40;PS-7<span class="elsevierStyleHsp" style=""></span>cm H2O&#41;&#46; Os principais resultados foram as taxas de sucesso do teste de desmame e o tempo at&#233; a extuba&#231;&#227;o bem sucedida&#46; Os resultados secund&#225;rios foram o tempo em que estiveram na UCI e no hospital&#44; mortalidade hospitalar e ocorr&#234;ncia de pneumonia associada ao ventilador &#40;VAP&#41;&#46; Resultados&#58; Dos 120 pacientes &#40;61 homens&#44; m&#233;dia de idade de 35 anos&#41;&#44; 58 foram atribu&#237;dos ao grupo de PS e 62 ao grupo de SBT&#46; A dura&#231;&#227;o m&#233;dia &#40;IQR&#41; da ventila&#231;&#227;o antes do desmame foi de 80&#44;2 &#40;50&#44;5---175&#44;6&#41; horas&#46; Os par&#226;metros basais foram semelhantes nos dois grupos&#44; exceto a taxa PaO2&#47;FiO2&#44; que foi significativamente superior no grupo de SBT&#46; As taxas de testes de desmame bem-sucedido &#40;89&#44;7&#37; versus 69&#44;4&#37;&#41; foram significativamente superiores no grupo de PS&#46; A dura&#231;&#227;o m&#233;dia de desmame &#40;66 versus 81&#44;5 horas&#44; p &#61; 0&#46;05&#41; e a dura&#231;&#227;o m&#233;dia de tempo na UCI &#40;8 versus 9&#44;4 dias&#44; p &#61; 0&#44;027&#41; foi inferior no grupo PS&#46; N&#227;o se registaram diferen&#231;as no tempo em que estiveram no hospital&#44; taxas de mortalidade ou ocorr&#234;ncia de VAP nos dois grupos&#46; Numa an&#225;lise multivariada&#44; a dura&#231;&#227;o de ventila&#231;&#227;o antes do desmame&#44; o &#237;ndice SOFA basal e o m&#233;todo de desmame foram preditores de uma extuba&#231;&#227;o bem sucedida&#46; Conclus&#245;es&#58; Descobriu-se que a redu&#231;&#227;o gradual da PS sem uma SBT inicial estava associada com melhores resultados comparados com PS apoiada pela SBT uma vez por dia&#46;</p>"
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