Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial
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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.
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.
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.
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.
KeywordsWeaning Mechanical ventilation Reintubation Rest
- 5.MacIntyre NR, Cook DJ, Ely EW Jr et al (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 120(6 Suppl):375S–395SCrossRefPubMedGoogle Scholar
- 14.Blackwood B, Burns KEA, Cardwell CR, O’Halloran P (2014) Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane Database Syst Rev 11:CD006904Google Scholar
- 19.Fernandez MM, Fernandez R, Magret M et al (2016) Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces extubation failure and reintubation in critically ill patients: a multicenter randomised controlled trial. Intensive Care Med Exp 4(Suppl 1: part two):470Google Scholar