Portal de investigación
Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial
Autores de IIS La Fe
Participantes ajenos a IIS La Fe
- Fernandez, MM
- Gonzalez-Castro, A
- Magret, M
- Bouza, MT
- Ibañez M
- Garcia, C
- Mas, A
- Arauzo, V
- Añón JM
- Ruiz, F
- Ferreres, J
- Tomas, R
- Alabert, M
- Tizon, AI
- Altaba, S
- Llamas, N
- Fernandez, R
Grupos
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.
Datos de la publicación
- ISSN/ISSNe:
- 0342-4642, 1432-1238
- Tipo:
- Article
- Páginas:
- 1660-1667
- Factor de Impacto:
- 3,293 SCImago ℠
- Cuartil:
- Q1 SCImago ℠
INTENSIVE CARE MEDICINE SPRINGER
Citas Recibidas en Web of Science: 41
Documentos
- No hay documentos
Filiaciones
Keywords
- Weaning; Mechanical ventilation; Reintubation; Rest
Proyectos asociados
PRESION INTRABDOMINAL Y TOLERANCIA A LA NUTRICION ENTERAL
Investigador Principal: BEGOÑA BALERDI PÉREZ
PIANE
Cita
Fernandez MM,Gonzalez A,Magret M,Bouza MT,Ibañez M,Garcia C,Balerdi B,Mas A,Arauzo V,Añón JM,Ruiz F,Ferreres J,Tomas R,Alabert M,Tizon AI,Altaba S,Llamas N,Fernandez R. Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial. Intensive Care Med. 2017. 43. (11):p. 1660-1667. IF:15,008. (1).