Comparison of spontaneous breathing test techniques for heart failure patients: A single-center, prospective,...

Standardized spontaneous breathing trial (SBT) techniques for patients with heart failure (HF) are lacking.

To compare the efficacy of low-level pressure-supported ventilation (PSV) and T-piece SBT techniques in patients with HF.

This single-center, prospective, open-label, randomized controlled study enrolled mechanically ventilated adults with stage B⁺ HF (Nov 2022-Apr 2024). Participants were randomized to the PSV or the T-piece group for a 30-minute SBT. Immediate extubation followed successful SBT. The primary endpoint was extubation success rate.

Neither SBT nor extubation success rates differed significantly between PSV and T-pece groups. The PSV group maintained stable oxygenation during the SBT (P = 0.066), while the T-piece group significantly reduced the oxygenation index (P = 0.005). No intergroup differences existed in the ICU/hospital stays, mechanical ventilation duration, or mortality outcomes. Echocardiography revealed a higher baseline left ventricular filling pressure in SBT-failure patients (median 12.07 vs. 8.11, P = 0.002) and poorer left ventricular diastolic function in extubation-failure cases at 48 h post-extubation (median 0.65 vs. 0.85, P = 0.004).

Low-level PSV may be preferable for weaning patients with HF.Ultrasound serves as a critical tool for assessment and outcome prediction.