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Published on: September 16, 2019
Effect of Protocolized Weaning and Spontaneous Breathing Trial vs Conventional Weaning on Duration of Mechanical
Rashmi Kishore1, Urmila Jhamb1
1Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India.
Insights
A pressure support spontaneous breathing trial (PS SBT) protocol for weaning pediatric patients from mechanical ventilation (MV) is safe and does not increase extubation failure. This protocol did not shorten MV duration but reliably assessed readiness for extubation.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Clinical Trial Design
Background:
- Optimizing mechanical ventilation (MV) duration in pediatric patients is critical to minimize complications.
- Premature extubation risks reintubation, while delayed weaning prolongs ventilation-associated morbidities.
- This study evaluated a protocolized weaning approach using pressure support spontaneous breathing trials (PS SBT) against conventional physician-directed weaning.
Observation:
- A prospective randomized controlled trial involved 80 pediatric patients requiring MV for ≥24 hours.
- The intervention group underwent a 2-hour PS SBT followed by a T-piece trial and extubation.
- Control patients received conventional weaning with synchronized intermittent mandatory ventilation and a T-piece trial.
Findings:
- No significant difference in MV duration (median 4.77 vs. 4.94 days) or extubation failure rates (13% vs. 10.5%) was observed between the PS SBT and control groups.
- Approximately 77.5% of patients successfully passed the PS SBT on the first attempt.
- Mortality was significantly higher in reintubated patients across both groups (p=0.002-0.005).
Implications:
- Protocolized weaning with PS SBT is a safe method for assessing extubation readiness in pediatric intensive care.
- While not reducing MV duration, this protocol avoids increasing extubation failure rates.
- Further research may explore optimizing PS SBT parameters to potentially shorten ventilation duration.
Background:
Identifying ventilated patients ready for extubation is a challenge for clinicians. Premature extubation increases risks of reintubation while delayed weaning increases complications of prolonged ventilation. We compared the duration of mechanical ventilation (MV) and extubation failure in children extubated using a weaning protocol based on pressure support spontaneous breathing trial (PS SBT) vs those extubated after nonprotocolized physician-directed weaning.
Patients And Methods:
A prospective randomized controlled trial was conducted in the pediatric intensive care unit of a tertiary care hospital in children ventilated for ≥24 hours. All eligible patients underwent daily screening and were randomized once found fit. The intervention group underwent PS SBT of 2 hours duration followed by a T-piece trial and extubation. Controls underwent conventional weaning with synchronized intermittent mandatory ventilation mode and a T-piece trial before extubation.
Results:
Eighty patients were randomized into two groups of 40 each. About 77.5% of patients passed the PS SBT on the first attempt. No statistical difference was found either in the duration of MV between the two groups [median (interquartile range) in days: 4.77 (2.89, 9.46) in controls and 4.94 (2.23, 6.35) in cases, p = 0.62] or in the rate of extubation failure (13% and 10.5%, p = 1). Mortality was found to be significantly higher in the reintubated patients compared to those not reintubated in both groups (p = 0.002 in cases and 0.005 in controls).
Conclusion:
Weaning using PS SBT-based protocol though did not shorten the duration of MV, it was found to be safe for assessing extubation readiness and did not increase extubation failure (CTRI no-CTRI/2018/04/013270).
How To Cite This Article:
Kishore R, Jhamb U. Effect of Protocolized Weaning and Spontaneous Breathing Trial vs Conventional Weaning on Duration of Mechanical Ventilation: A Randomized Controlled Trial. Indian J Crit Care Med 2021;25(9):1059-1065.
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