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Intensive Care Medicine

, Volume 43, Issue 11, pp 1660–1667 | Cite as

Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial

  • M. Mar FernandezEmail author
  • Alejandro González-Castro
  • Monica Magret
  • M. Teresa Bouza
  • Marcos Ibañez
  • Carolina García
  • Begoña Balerdi
  • Arantxa Mas
  • Vanesa Arauzo
  • José M. Añón
  • Francisco Ruiz
  • José Ferreres
  • Roser Tomás
  • Marta Alabert
  • Ana Isabel Tizón
  • Susana Altaba
  • Noemi Llamas
  • Rafael Fernandez
Original

Abstract

Background

Spontaneous breathing trials (SBT) can be exhausting, but the preventive role of rest has never been studied. This study aimed to evaluate whether reconnection to mechanical ventilation (MV) for 1 h after the effort of a successful SBT could reduce the need for reintubation in critically ill patients.

Methods

Randomized multicenter trial conducted in 17 Spanish medical-surgical intensive care units (Oct 2013–Jan 2015). Patients under MV for longer than 12 h who fulfilled criteria for planned extubation were randomly allocated after a successful SBT to direct extubation (control group) or reconnection to the ventilator for a 1-h rest before extubation (rest group). The primary outcome was reintubation within 48 h. Analysis was by intention to treat.

Results

We recruited 243 patients randomized to the control group and 227 to the rest group. Median time from intubation to SBT did not differ between groups [5.5 (2.7, 9.6) days in the control group vs. 5.7 (2.7, 10.6) in the rest group; p = 0.85]. Reintubation within 48 h after extubation was more common in the control than in the rest group [35 (14%) vs. 12 (5%) patients; OR 0.33; 95% CI 0.16–0.65; p < 0.001]. A multivariable regression model demonstrated that the variables independently associated with reintubation were rest [OR 0.34 (95%CI 0.17–0.68)], APACHE II [OR 1.04 (1.002–1.077)], and days of MV before SBT [OR 1.04 (1.001–1.073)], whereas age, reason for admission, and type and duration of SBT were not.

Conclusion

One-hour rest after a successful SBT reduced the rates of reintubation within 48 h after extubation in critically ill patients.

Trial registration Clinicaltrials.gov identifier NCT01915563.

Keywords

Weaning Mechanical ventilation Reintubation Rest 

Supplementary material

134_2017_4911_MOESM1_ESM.doc (130 kb)
Supplementary material 1 (DOC 129 kb)
134_2017_4911_MOESM2_ESM.doc (253 kb)
Supplementary material 2 (DOC 253 kb)

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Copyright information

© Springer-Verlag GmbH Germany and ESICM 2017

Authors and Affiliations

  • M. Mar Fernandez
    • 1
    Email author
  • Alejandro González-Castro
    • 2
  • Monica Magret
    • 3
  • M. Teresa Bouza
    • 4
  • Marcos Ibañez
    • 5
  • Carolina García
    • 6
  • Begoña Balerdi
    • 7
  • Arantxa Mas
    • 8
  • Vanesa Arauzo
    • 9
  • José M. Añón
    • 10
  • Francisco Ruiz
    • 11
  • José Ferreres
    • 12
  • Roser Tomás
    • 13
  • Marta Alabert
    • 14
  • Ana Isabel Tizón
    • 15
  • Susana Altaba
    • 16
  • Noemi Llamas
    • 17
  • Rafael Fernandez
    • 18
  1. 1.Department of Intensive CareHospital Universitari Mútua TerrassaTerrassaSpain
  2. 2.Department of Intensive CareHospital Universitario Marqués de ValdecillaSantanderSpain
  3. 3.Department of Intensive CareHospital Universitari Joan XXIIITarragonaSpain
  4. 4.Department of Intensive CareHospital de A CoruñaCoruñaSpain
  5. 5.Department of Intensive CareHospital Verge de la Cinta de TortosaTarragonaSpain
  6. 6.Department of Intensive CareHospital Universitario de CanariasTenerifeSpain
  7. 7.Department of Intensive CareHospital Universitario La FeValenciaSpain
  8. 8.Department of Intensive CareConsorci Sanitari Integral Moisés BroggiBarcelonaSpain
  9. 9.Department of Intensive CareConsorci Hospitalari de TerrassaTerrassaSpain
  10. 10.Department of Intensive CareHospital Universitario La Paz-Carlos III. IdiPAZ. CIBERESMadridSpain
  11. 11.Department of Intensive CareHospital Médico-quirúrgico de JaénJaénSpain
  12. 12.Department of Intensive CareHospital Clínico de ValenciaValenciaSpain
  13. 13.Department of Intensive CareHospital General de CatalunyaBarcelonaSpain
  14. 14.Department of Intensive CareHospital General de VicBarcelonaSpain
  15. 15.Department of Intensive CareComplexo Hospitalario Universitario de OurenseOurenseSpain
  16. 16.Department of Intensive CareHospital General Universitario de CastellónCastellónSpain
  17. 17.Department of Intensive CareHospital Universitario Rafael MéndezMurciaSpain
  18. 18.Department of Intensive Care, Hospital Sant Joan de Dèu -Fundació Althaia, CIBERESUniversitat Internacional de CatalunyaManresaSpain

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