The impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: A randomized controlled trial

The impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: A randomized controlled trial

Author Foronda, Flavia K. Google Scholar
Troster, Eduardo J. Google Scholar
Farias, Julio A. Google Scholar
Barbas, Carmen S. Google Scholar
Ferraro, Alexandre A. Google Scholar
Faria, Lucilia S. Google Scholar
Bousso, Albert Google Scholar
Panico, Flavia F. Google Scholar
Delgado, Artur F. Google Scholar
Institution Hosp Sirio Libanes
Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
Hosp Albert Einstein
Univ Buenos Aires
Abstract Objectives: To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation.Design: A prospective, randomized controlled trial.Setting: Two pediatric intensive care units at university hospitals in Brazil.Patients: the trial involved children between 28 days and 15 yrs of age who were receiving mechanical ventilation for at least 24 hrs.Interventions: Patients were randomly assigned to one of two weaning protocols. in the test group, the children underwent a daily evaluation to check readiness for weaning with a spontaneous breathing test with 10 cm H(2)O pressure support and a positive end-expiratory pressure of 5 cm H(2)O for 2 hrs. the spontaneous breathing test was repeated the next day for children who failed it. in the control group, weaning was performed according to standard care procedures.Measurements and Main Results: A total of 294 eligible children were randomized, with 155 to the test group and 139 to the control group. the time to extubation was shorter in the test group, where the median mechanical ventilation duration was 3.5 days (95% confidence interval, 3.0 to 4.0) as compared to 4.7 days (95% confidence interval, 4.1 to 5.3) in the control group (p = .0127). This significant reduction in the mechanical ventilation duration for the intervention group was not associated with increased rates of extubation failure or noninvasive ventilation. It represents a 30% reduction in the risk of remaining on mechanical ventilation (hazard ratio: 0.70).Conclusions: A daily evaluation to check readiness for weaning combined with a spontaneous breathing test reduced the mechanical ventilation duration for children on mechanical ventilation for > 24 hrs, without increasing the extubation failure rate or the need for noninvasive ventilation. (Crit Care Med 2011; 39: 2526-2533)
Keywords artificial
respiration
intensive care units
pediatrics
randomized controlled trial
respiratory insufficiency
ventilator weaning
Language English
Date 2011-11-01
Published in Critical Care Medicine. Philadelphia: Lippincott Williams & Wilkins, v. 39, n. 11, p. 2526-2533, 2011.
ISSN 0090-3493 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 2526-2533
Origin http://dx.doi.org/10.1097/CCM.0b013e3182257520
Access rights Closed access
Type Article
Web of Science ID WOS:000296509500020
URI http://repositorio.unifesp.br/handle/11600/34207

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