Spontaneous breathing trial with pressure support on positive end-expiratory pressure and extensive use of non-invasive ventilation versus T-piece in difficult-to-wean patients from mechanical ventilation: a randomized controlled trial

被引:5
作者
Mezidi, Mehdi [1 ,2 ]
Yonis, Hodane [1 ]
Chauvelot, Louis [1 ]
Deniel, Guillaume [1 ,2 ,3 ]
Dhelft, Francois [1 ,2 ]
Gaillet, Maxime [1 ,2 ]
Noirot, Ines [1 ]
Folliet, Laure [1 ]
Chabert, Paul [1 ]
David, Guillaume [1 ]
Danjou, William [1 ]
Baboi, Loredana [1 ]
Bettinger, Clotilde [1 ]
Bernon, Pauline [1 ]
Girard, Mehdi [1 ]
Provoost, Judith [1 ]
Bazzani, Alwin [1 ]
Bitker, Laurent [1 ,2 ,3 ]
Richard, Jean-Christophe [1 ,2 ,3 ]
机构
[1] Hosp Civils Lyon, Croix Rousse Hosp, Med Intens Care Unit, Lyon, France
[2] Univ Lyon, Univ Lyon 1, Lyon, France
[3] CREATIS, CNRS 5220, INSERM 1044, Villeurbanne, France
关键词
Pressure support; Spontaneous breathing trial; T-piece; Positive end-expiratory pressure; Difficult weaning; EXTUBATION; TUBE; PROTOCOL;
D O I
10.1186/s13613-024-01290-6
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background The aim of this study is to assess whether a strategy combining spontaneous breathing trial (SBT) with both pressure support (PS) and positive end-expiratory pressure (PEEP) and extended use of post-extubation non-invasive ventilation (NIV) (extensively-assisted weaning) would shorten the time until successful extubation as compared with SBT with T-piece (TP) and post-extubation NIV performed in selected patients as advocated by guidelines (standard weaning), in difficult-to-wean patients from mechanical ventilation.Methods The study is a single-center prospective open label, randomized controlled superiority trial with two parallel groups and balanced randomization with a 1:1 ratio. Eligible patients were intubated patients mechanically ventilated for more than 24 h who failed their first SBT using TP. In the extensively-assisted weaning group, SBT was performed with PS (7 cmH2O) and PEEP (5 cmH2O). In case of SBT success, an additional SBT with TP was performed. Failure of this SBT-TP was an additional criterion for post-extubation NIV in this group in addition to other recommended criteria. In the standard weaning group, SBT was performed with TP, and NIV was performed according to international guidelines. The primary outcome criterion was the time between inclusion and successful extubation evaluated with a Cox model with adjustment on randomization strata.Results From May 2019 to March 2023, 98 patients were included and randomized in the study (49 in each group). Four patients were excluded from the intention-to-treat population (2 in both groups); therefore, 47 patients were analyzed in each group. The extensively-assisted weaning group had a higher median age (68 [58-73] vs. 62 [55-71] yrs.) and similar sex ratio (62% male vs. 57%). Time until successful extubation was not significantly different between extensively-assisted and standard weaning groups (median, 172 [50-436] vs. 95 [47-232] hours, Cox hazard ratio for successful extubation, 0.88 [95% confidence interval: 0.55-1.42] using the standard weaning group as a reference; p = 0.60). All secondary outcomes were not significantly different between groups.Conclusion An extensively-assisted weaning strategy did not lead to a shorter time to successful extubation than a standard weaning strategy. Trial registration The trial was registered on ClinicalTrials.gov (NCT03861117), on March 1, 2019, before the inclusion of the first patient. https://clinicaltrials.gov/study/NCT03861117.Conclusion An extensively-assisted weaning strategy did not lead to a shorter time to successful extubation than a standard weaning strategy. Trial registration The trial was registered on ClinicalTrials.gov (NCT03861117), on March 1, 2019, before the inclusion of the first patient. https://clinicaltrials.gov/study/NCT03861117.
引用
收藏
页数:11
相关论文
共 26 条
[1]  
[Anonymous], 2023, R: a language and environment for statistical computing
[2]  
[Anonymous], 2018, Global Strategy for the Diagnosis, Management and Prevention of COPD
[3]   Epidemiology of Weaning Outcome according to a New Definition The WIND Study [J].
Beduneau, Gaetan ;
Pham, Tai ;
Schortgen, Frederique ;
Piquilloud, Lise ;
Zogheib, Elie ;
Jonas, Maud ;
Grelon, Fabien ;
Runge, Isabelle ;
Terzi, Nicolas ;
Grange, Steven ;
Barberet, Guillaume ;
Guitard, Pierre-Gildas ;
Frat, Jean-Pierre ;
Constan, Adrien ;
Chretien, Jean-Marie ;
Mancebo, Jordi ;
Mercat, Alain ;
Richard, Jean-Christophe M. ;
Brochard, Laurent .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2017, 195 (06) :772-783
[4]   COMPARISON OF 3 METHODS OF GRADUAL WITHDRAWAL FROM VENTILATORY SUPPORT DURING WEANING FROM MECHANICAL VENTILATION [J].
BROCHARD, L ;
RAUSS, A ;
BENITO, S ;
CONTI, G ;
MANCEBO, J ;
REKIK, N ;
GASPARETTO, A ;
LEMAIRE, F .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1994, 150 (04) :896-903
[5]   Ventilator Weaning and Discontinuation Practices for Critically Ill Patients [J].
Burns, Karen E. A. ;
Rizvi, Leena ;
Cook, Deborah J. ;
Lebovic, Gerald ;
Dodek, Peter ;
Villar, Jesus ;
Slutsky, Arthur S. ;
Jones, Andrew ;
Kapadia, Farhad N. ;
Gattas, David J. ;
Epstein, Scott K. ;
Pelosi, Paolo ;
Kefala, Kallirroi ;
Meade, Maureen O. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2021, 325 (12) :1173-1184
[6]   Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis [J].
Burns, Karen E. A. ;
Soliman, Ibrahim ;
Adhikari, Neill K. J. ;
Zwein, Amer ;
Wong, Jessica T. Y. ;
Gomez-Builes, Carolina ;
Pellegrini, Jose Augusto ;
Chen, Lu ;
Rittayamai, Nuttapol ;
Sklar, Michael ;
Brochard, Laurent J. ;
Friedrich, Jan O. .
CRITICAL CARE, 2017, 21
[7]   Physiological comparison of three spontaneous breathing trials in difficult-to-wean patients [J].
Cabello, Belen ;
Thille, Arnaud W. ;
Roche-Campo, Ferran ;
Brochard, Laurent ;
Gomez, Francisco J. ;
Mancebo, Jordi .
INTENSIVE CARE MEDICINE, 2010, 36 (07) :1171-1179
[8]  
Dayimu A., 2023, forestploter: Create Flexible Forest Plot. R package version 1.1.1
[9]   A COMPARISON OF 4 METHODS OF WEANING PATIENTS FROM MECHANICAL VENTILATION [J].
ESTEBAN, A ;
FRUTOS, F ;
TOBIN, MJ ;
ALIA, I ;
SOLSONA, JF ;
VALVERDU, I ;
FERNANDEZ, R ;
DELACAL, MA ;
BENITO, S ;
TOMAS, R ;
CARRIEDO, D ;
MACIAS, S ;
BLANCO, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 332 (06) :345-350
[10]   Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation [J].
Esteban, A ;
Alia, I ;
Gordo, F ;
Fernandez, R ;
Solsona, JF ;
Vallverdu, I ;
Macias, S ;
Allegue, M ;
Blanco, J ;
Carriedo, D ;
Leon, M ;
delaCal, MA ;
Taboada, F ;
deVelasco, JG ;
Palazon, E ;
Carrizosa, F ;
Tomas, R ;
Suarez, J ;
Goldwasser, RS .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1997, 156 (02) :459-465