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Erschienen in: Intensive Care Medicine 11/2017

22.09.2017 | Original

Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial

verfasst von: M. Mar Fernandez, Alejandro González-Castro, Monica Magret, M. Teresa Bouza, Marcos Ibañez, Carolina García, Begoña Balerdi, Arantxa Mas, Vanesa Arauzo, José M. Añón, Francisco Ruiz, José Ferreres, Roser Tomás, Marta Alabert, Ana Isabel Tizón, Susana Altaba, Noemi Llamas, Rafael Fernandez

Erschienen in: Intensive Care Medicine | Ausgabe 11/2017

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.
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Metadaten
Titel
Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial
verfasst von
M. Mar Fernandez
Alejandro González-Castro
Monica Magret
M. Teresa Bouza
Marcos Ibañez
Carolina García
Begoña Balerdi
Arantxa Mas
Vanesa Arauzo
José M. Añón
Francisco Ruiz
José Ferreres
Roser Tomás
Marta Alabert
Ana Isabel Tizón
Susana Altaba
Noemi Llamas
Rafael Fernandez
Publikationsdatum
22.09.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 11/2017
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-017-4911-0

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