Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group.
نویسندگان
چکیده
The duration of spontaneous breathing trials before extubation has been set at 2 h in research studies, but the optimal duration is not known. We conducted a prospective, multicenter study involving 526 ventilator-supported patients considered ready for weaning, to compare clinical outcomes for trials of spontaneous breathing with target durations of 30 and 120 min. Of the 270 and 256 patients in the 30- and 120-min trial groups, respectively, 237 (87.8%) and 216 (84.8%), respectively, completed the trial without distress and were extubated (p = 0.32); 32 (13.5%) and 29 (13.4%), respectively, of these patients required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after a spontaneous breathing trial did not differ in the 30- and 120-min trial groups (75.9% versus 73.0%, respectively, p = 0.43). The 30- and 120-min trial groups had similar within-unit mortality rates (13 and 9%, respectively) and in-hospital mortality rates (19 and 18%, respectively). Reintubation was required in 61 (13.5%) patients, and these patients had a higher mortality (20 of 61, 32.8%) than did patients who tolerated extubation (18 of 392, 4.6%) (p < 0.001). Neither measurements of respiratory frequency, heart rate, systolic blood pressure, and oxygen saturation during the trial, nor other functional measurements before the trial discriminated between patients who required reintubation from those who tolerated extubation. In conclusion, after a first trial of spontaneous breathing, successful extubation was achieved equally effectively with trials targeted to last 30 and 120 min.
منابع مشابه
A Randomized Clinical Trial to Compare the Criteria of Readiness for Extubation and Daily Spontaneous Breathing Test (SBT) on the Duration of Mechanical Ventilation
Background: Successful weaning of the ventilator is a major challenge, especially in children. This study was conducted to compare the criteria of readiness for extubation and daily spontaneous breathing test (SBT) on the duration of mechanical ventilation and extubation failure rates. Materials and Metho...
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Background About 40 to 60% of all patients admitted to pediatric intensive care unitsundergo mechanical ventilation and 10 to 20% will fail to be extubated. We aimed to determine the role of the rapid shallow breathing index (RSBI) in predicting successful weaning of pediatric patients with respiratory failure. Materials and Methods: This cross-sectional study, was performed on 72 mechanical...
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A 2-h T-tube trial of spontaneous breathing was used in selecting patients ready for extubation and discontinuation of mechanical ventilation. However, some doubt remains as to whether it is the most appropriate method of performing a spontaneous breathing trial. We carried out a prospective, randomized, multicenter study involving patients who had received mechanical ventilation for more than ...
متن کاملThe impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: a randomized controlled trial.
OBJECTIVES To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation. DESIGN A prospective, randomized controlled trial. SETTING Two pediatric inte...
متن کامل[Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously].
BACKGROUND Prompt recognition of the reversal of respiratory failure may permit earlier discontinuation of mechanical ventilation, without harm to the patient. METHODS We conducted a randomized, controlled trial in 300 adult patients receiving mechanical ventilation in medical and coronary intensive care units. In the intervention group, patients underwent daily screening of respiratory funct...
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ورودعنوان ژورنال:
- American journal of respiratory and critical care medicine
دوره 159 2 شماره
صفحات -
تاریخ انتشار 1999