PURPOSE: Unnecessary delays in discontinuation of ventilatory support increases the complication rate from mechanical ventilation (eg, pneumonia, airway trauma) as well as the cost. Addition of positive end expiratory pressure (PEEP) reduces work of breathing, and promotes weaning by various mechanism. We conducted a pilot study to test the utility of a PEEP-valve to assist in liberation from ventilatory support.
METHODS: Patients requiring persistent ventilatory support, and were unable to tolerate a T-piece trial, were placed on T-piece with a non-adjustable PEEP valve ( PEEP range 5 to 12.5 cm H2O). A high flow gas induction nebulizer (GIN) allowed maintenance of desired FiO2.
RESULTS: T-piece with PEEP valve was well tolerated. None of the six patients required to be placed back on ventilator again. There were no complications from the apparatus.
CONCLUSION: The addition of a PEEP valve to T-piece is successful in liberating patients from mechanical ventilation earlier.
CLINICAL IMPLICATIONS: Routine use of a PEEP valve may be a simple and extremely cost-effective method of avoiding prolonged ventilatory support (and the resulting complications) in difficult-to-wean patients.
DISCLOSURE: Patrick Clements, None.