Weaning from mechanical ventilation is more successful after brief pressure-support trial

  • Subirà C & al.
  • JAMA
  • 11 Jun 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • For adults ready for weaning from mechanical ventilation (MV), a brief spontaneous breathing trial (SBT) of pressure support ventilation (PSV) leads to more successful extubations than does 2 hours with T-piece ventilation.
  • Editorial: trial is “important and welcome,” but:
    • Results not applicable to patients with 1 unsuccessful SBT, 
    • Trial did not account for noninvasive interventions, and
    • Long-term outcomes were not assessed.

Why this matters

  • Both failed and delayed extubation are associated with worse outcomes.
  • Optimal SBT parameters are debated.

Key results

  • 1018 completed trial.
  • PSV vs T-piece:
    • Successful extubation:
      • 82.3% (473) vs 74% (428);
      • Difference, 8.2% (95% CI, 3.4%-13%);
      • HR, 1.54 (95% CI, 1.19-1.97; P<.001>
    • Hospital mortality:
      • 10.4% vs 14.9%;
      • Difference, −4.4% (95% CI, 8.3% to 0.6%; P=.02).
    • 90-day mortality:
      • 13.2% vs 17.3%;
      • Difference, −4.1% (95% CI, 8.2% to 0.01%; P=.04);
      • HR, 0.74 (95% CI, 0.55-0.99).
    • Similar rates of reintubation and hospital, ICU lengths of stay.

Study design

  • Randomized multi-ICU clinical trial, adults judged ready for weaning from MV (n=1153).
  • Participants were randomly assigned to either:
    • 30 minutes of PSV, 8 cm H2O; or
    • 2 hours of T-piece ventilation.
  • Outcome: successful extubation.
  • Funding: Societat Catalana de Medicina Intensiva i Critica (Spain).

Limitations

  • Noninvasive ventilation, high-flow nasal cannula not assessed.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit