| Title: |
Frequency of Screening and Spontaneous Breathing Trial Techniques ; A Randomized Clinical Trial |
| Authors: |
Burns, Karen E. A.; Wong, Jessica; Rizvi, Leena; Lafreniere-Roula, Myriam; Thorpe, Kevin; Devlin, John W.; Cook, Deborah J.; Seely, Andrew; Dodek, Peter M.; Tanios, Maged; Piraino, Thomas; Gouskos, Audrey; Kiedrowski, Kenneth C.; Kay, Phyllis; Mitchell, Susan; Merner, George W.; Mayette, Michael; D’Aragon, Frederick; Lamontagne, Francois; Rochwerg, Bram; Turgeon, Alexis; Sia, Ying Tung; Charbonney, Emmanuel; Aslanian, Pierre; Criner, Gerard J.; Hyzy, Robert C.; Beitler, Jeremy R.; Kassis, Elias Baedorf; Kutsogiannis, Demetrios James; Meade, Maureen O.; Liebler, Janice; Iyer-Kumar, Santhi; Tsang, Jennifer; Cirone, Robert; Shanholtz, Carl; Hill, Nicholas S.; Dawdy, Kim; Mariano, Zana; Sandhu, Gyan; Santos, Marlene; Khalid, Imrana; Salway, Kurtis; Hodder, Jennifer; Smith, Orla; Hajj, Jessica; Buchanan, Samantha; Severdija, Vivianne; Medvetskaya, Anna; Enriquez, Sarah; Michaels, John |
| Source: |
JAMA ; volume 332, issue 21, page 1808 ; ISSN 0098-7484 |
| Publisher Information: |
American Medical Association (AMA) |
| Publication Year: |
2024 |
| Description: |
Importance The optimal screening frequency and spontaneous breathing trial (SBT) technique to liberate adults from ventilators are unknown. Objective To compare the effects of screening frequency (once-daily screening vs more frequent screening) and SBT technique (pressure-supported SBT with a pressure support level that was >0-≤8 cm H 2 O and a positive end-expiratory pressure [PEEP] level that was >0-≤5 cm H 2 O vs T-piece SBT) on the time to successful extubation. Design, Setting, and Participants Randomized clinical trial with a 2 × 2 factorial design including critically ill adults who were receiving invasive mechanical ventilation for at least 24 hours, who were capable of initiating spontaneous breaths or triggering ventilators, and who were receiving a fractional concentration of inspired oxygen that was 70% or less and a PEEP level of 12 cm H 2 O or less. Recruitment was between January 2018 and February 2022 at 23 intensive care units in North America; last follow-up occurred October 18, 2022. Interventions Participants were enrolled early to enable protocolized screening (more frequent vs once daily) to identify the earliest that patients met criteria to undergo pressure-supported or T-piece SBT lasting 30 to 120 minutes. Main Outcome and Measures Time to successful extubation (time when unsupported, spontaneous breathing began and was sustained for ≥48 hours after extubation). Results Of 797 patients (198 in the once-daily screening and pressure-supported SBT group, 204 in once-daily screening and T-piece SBT, 195 in more frequent screening and pressure-supported SBT, and 200 in more frequent screening and T-piece SBT), the mean age was 62.4 (SD, 18.4) years and 472 (59.2%) were men. There were no statistically significant differences by screening frequency (hazard ratio [HR], 0.88 [95% CI, 0.76-1.03]; P = .12) or by SBT technique (HR, 1.06 [95% CI, 0.91-1.23]; P = .45). The median time to successful extubation was 2.0 days (95% CI, 1.7-2.7) for once-daily screening and ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1001/jama.2024.20631 |
| Availability: |
https://doi.org/10.1001/jama.2024.20631; https://jamanetwork.com/journals/jama/articlepdf/2824928/jama_burns_2024_oi_240116_1732230501.35635.pdf |
| Accession Number: |
edsbas.C2246226 |
| Database: |
BASE |