Interrelationship between the duration of a spontaneous breathing trial, tension-time index of the diaphragm, and predicted time to task failure in 9 patients.

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Interrelationship between the duration of a spontaneous breathing trial, tension-time index of the diaphragm, and predicted time to task failure in 9 patients who failed a trial of weaning from mechanical ventilation. Interrelationship between the duration of a spontaneous breathing trial, tension-time index of the diaphragm, and predicted time to task failure in 9 patients who failed a trial of weaning from mechanical ventilation. The patients breathed spontaneously for an average of 44 min before a physician terminated the trial. At the start of the trial, the tension-time index was 0.17, and the formula of Bellemare and Grassino (6) (see text for details) predicted that patients could sustain spontaneous breathing for another 59 min before developing task failure. As the trial progressed, the tension-time index increased, and the predicted time to development of task failure decreased. At the end of the trial, the tension-time index reached 0.26. That patients were predicted to sustain spontaneous breathing for another 13 min before developing task failure clarifies why patients did not develop a decrease in diaphragmatic twitch pressure. In other words, physicians interrupted the trial on the basis of clinical manifestations of respiratory distress, before patients had sufficient time to develop contractile fatigue. [Reproduced from Laghi and Tobin (40) from an official journal of the American Thoracic Society, with permission. Copyright American Thoracic Society.] Martin J. Tobin et al. J Appl Physiol 2009;107:962-970 ©2009 by American Physiological Society