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Intensive Care Med. 2017 Nov;43(11):1660-1667. doi: 10.1007/s00134-017-4911-0. Epub 2017 Sep 22.

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

Author information

1
Department of Intensive Care, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Terrassa, Spain. marufaes@yahoo.es.
2
Department of Intensive Care, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
3
Department of Intensive Care, Hospital Universitari Joan XXIII, Tarragona, Spain.
4
Department of Intensive Care, Hospital de A Coruña, Coruña, Spain.
5
Department of Intensive Care, Hospital Verge de la Cinta de Tortosa, Tarragona, Spain.
6
Department of Intensive Care, Hospital Universitario de Canarias, Tenerife, Spain.
7
Department of Intensive Care, Hospital Universitario La Fe, Valencia, Spain.
8
Department of Intensive Care, Consorci Sanitari Integral Moisés Broggi, Barcelona, Spain.
9
Department of Intensive Care, Consorci Hospitalari de Terrassa, Terrassa, Spain.
10
Department of Intensive Care, Hospital Universitario La Paz-Carlos III. IdiPAZ. CIBERES, Madrid, Spain.
11
Department of Intensive Care, Hospital Médico-quirúrgico de Jaén, Jaén, Spain.
12
Department of Intensive Care, Hospital Clínico de Valencia, Valencia, Spain.
13
Department of Intensive Care, Hospital General de Catalunya, Barcelona, Spain.
14
Department of Intensive Care, Hospital General de Vic, Barcelona, Spain.
15
Department of Intensive Care, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
16
Department of Intensive Care, Hospital General Universitario de Castellón, Castellón, Spain.
17
Department of Intensive Care, Hospital Universitario Rafael Méndez, Lorca, Murcia, Spain.
18
Department of Intensive Care, Hospital Sant Joan de Dèu -Fundació Althaia, CIBERES, Universitat Internacional de Catalunya, Manresa, Spain.

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.

KEYWORDS:

Mechanical ventilation; Reintubation; Rest; Weaning

PMID:
28936675
DOI:
10.1007/s00134-017-4911-0
[Indexed for MEDLINE]

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