Comparison of T-Piece and Pressure Support Ventilation During Spontaneous Breathing Trials in Weaning-Ready STEMI Patients Undergoing Primary PCI

Abstract

Objective: This study aimed to compare final T-piece and pressure support ventilation (PSV) spontaneous breathing trials (SBTs) with respect to extubation failure, defined as reintubation within 72 hours after extubation, among mechanically ventilated patients with ST-elevation myocardial infarction (STEMI) who survived the acute phase, became clinically stable, and fulfilled predefined criteria for ventilator liberation. Methodology: This prospective observational cohort study was conducted in the Cardiac Intensive Care Unit of a tertiary care cardiac center. Adult patients with STEMI undergoing primary percutaneous coronary intervention (PCI) who required invasive mechanical ventilation for ≥12 hours and subsequently fulfilled institutional SBT-readiness criteria were consecutively enrolled. The primary exposure was the final SBT immediately preceding extubation, performed using either a T-piece or PSV with 5 cmH₂O pressure support. The primary outcome was reintubation within 72 hours after extubation. Secondary outcomes included ICU and hospital length of stay, post-extubation non-invasive ventilation (NIV), and in-hospital mortality. Results: A total of 268 patients were included, of whom 136 underwent a final T-piece SBT and 132 underwent a PSV-based SBT. Mean age was 59.5 ± 11.2 years and 71.3% were male. All included patients successfully completed the final SBT, fulfilled extubation criteria, and were extubated. Reintubation within 72 hours occurred in 28 patients (10.4%), including 14/136 (10.3%) in the T-piece group and 14/132 (10.6%) in the PSV group (p=0.933). The absolute risk difference (PSV minus T-piece) was 0.3 percentage points (95% CI −7.0 to 7.6). Median hospital stay was 6 [IQR 5–7] days in the T-piece group and 5 [5–7] days in the PSV group (p=0.005), while hospital stay >5 days occurred in 64.7% versus 46.2%, respectively (p=0.002). Post-extubation NIV >24 hours was also more frequent following T-piece SBT (36.0% versus 18.9%; p=0.002). In-hospital mortality was 2.6% overall and did not differ significantly between groups. Conclusion: Among selected mechanically ventilated patients with STEMI undergoing primary PCI who survived, stabilized, and became eligible for ventilator liberation, no statistically significant difference in 72-hour reintubation was detected between final T-piece and PSV-based SBTs.