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Protocol-directed weaning from mechanical ventilation: clinical outcome in patients randomized for a 30-min or
Andreas Perren1, Guido Domenighetti, Simonetta Mauri
1Centro Cure Intense, Ospedale Regionale Bellinzona e Valli, 6500 Bellinzona, Switzerland. andreas.perren@eoc.ch
Objective:
To investigate the possibility of successful extubation performing a spontaneous breathing trial (SBT) in pressure support ventilation (PSV) with target durations of 30 and 120 min.
Design And Setting:
Prospective and randomized study in two medical-surgical adult intensive care units.
Patients And Participants:
98 adult patients supported by mechanical ventilation for at least 48 h and considered ready for a weaning trial.
Interventions:
An SBT conducted in PSV with 7 cmH(2)O and patients randomly assigned to two groups with target durations of 30- and 120-min.
Measurements And Results:
In the 30-min group 43 patients (93%) tolerated the SBT and were extubated while 4 (9%) needed reintubation within 48 h; in the 120-min group 46 patients (88%) successfully completed the trial and were extubated while 2 (4%) were reintubated. ICU mortality in the groups with short and long periods was 6% and 4%, and in-hospital mortality 20% and 17%, respectively. Those successful in the 30- and 120-min groups had similar length of ICU stay (6 and 7 days, respectively) and in-hospital length of stay (20 and 25 days, respectively). Compared to the successfully extubated, the reintubated patients had significantly higher length of ICU stay and mortality (17 vs. 6 days and 33 vs. 3.6%, respectively).
Conclusions:
An SBT with PSV of 7 cmH(2)O lasting 30 min is equally effective in recognizing the successfully extubated patients as a 120-min trial.