The Effect of Reconnection to Mechanical Ventilation for 1 Hour After Spontaneous Breathing Trial on Reintubation Among Patients Ventilated for More Than 12 Hours: A Randomized Clinical Trial.

Autor:	Dadam MM; Universidade da Região de Joinville-UNIVILLE, Joinville, Brazil; Centro Hospitalar Unimed, Joinville, Brazil; Hospital Municipal São José, Joinville, Brazil. Electronic address: mikidadam@gmail.com., Gonçalves ARR; Universidade da Região de Joinville-UNIVILLE, Joinville, Brazil; Centro Hospitalar Unimed, Joinville, Brazil., Mortari GL; Centro Hospitalar Unimed, Joinville, Brazil., Klamt AP; Hospital Municipal São José, Joinville, Brazil., Hippler A; Hospital Unimed Litoral, Balneário Camboriú, Brazil., Lago JU; Hospital Municipal São José, Joinville, Brazil., Ponikieski C; Centro Hospitalar Unimed, Joinville, Brazil., Catelano BA; Hospital Municipal São José, Joinville, Brazil., Delvan D; Hospital Municipal São José, Joinville, Brazil., Westphal GA; Universidade da Região de Joinville-UNIVILLE, Joinville, Brazil; Centro Hospitalar Unimed, Joinville, Brazil; Hospital Municipal São José, Joinville, Brazil; Brazilian Research in Intensive Care Network-BRICNet, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2021 Jul; Vol. 160 (1), pp. 148-156. Date of Electronic Publication: 2021 Mar 04.
DOI:	10.1016/j.chest.2021.02.064
Abstrakt:	Background: The resting of the respiratory musculature after undergoing the spontaneous breathing trial (SBT) to prevent extubation failures in critically ill patients needs to be studied further. Research Question: Is the reconnection to mechanical ventilation (MV) for 1 h after a successful SBT able to reduce the risk of reintubation? Study Design and Methods: Randomized clinical trial conducted in four ICUs between August 2018 and July 2019. Candidates for tracheal extubation who met all screening criteria for weaning were included. After achieving success in the SBT using a T-tube, the patients were randomized to the following groups: direct extubation (DE) or extubation after reconnection to MV for 1 h (R1h). The primary outcome was reintubation within 48 h. Results: Among the 336 patients studied (women, 41.1%; median age, 59 years [interquartile range, 45-70 years]), 12.9% (22/171) in the R1h group required reintubation within 48 h vs 18.2% (30/165) in the DE group (risk difference, 5.3 [95% CI, -2.49 to 13.12]; P = .18). No differences were found in mortality, length of ICU or hospital stay, causes of reintubation, or signs of extubation failure. A prespecified exploratory analysis showed that among the 233 patients (69.3%) who were ventilated for more than 72 h, the incidence of reintubation was 12.7% (15/118) in the R1h group compared with 22.6% (26/115) observed in the DE group (P = .04). Interpretation: Reconnection to MV after a successful SBT, compared with DE, did not result in a statistically significant reduction in the risk of reintubation in mechanically ventilated patients. Subgroup exploratory findings suggest that the strategy may benefit patients who were ventilated for more than 72 h, which should be confirmed in further studies. Trial Registry: Brazilian Clinical Trials Registry; No.: RBR-3x8nxn; URL: www.ensaiosclinicos.gov.br. (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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