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The following is a summary of “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,” published in the April 2024 issue of Critical Care by Mezidi et al.
Researchers conducted a retrospective study investigating if a weaning strategy combining pressure support (PS), spontaneous breathing trial (SBT) with positive end-expiratory pressure (PEEP), and extended non-invasive ventilation (NIV) use reduces time to successful extubation compared to standard weaning with T-piece (TP)-SBT and guideline-based NIV.
They conducted a single-center, open-label, randomized controlled superiority trial with two groups and balanced randomization (1:1 ratio). Patients eligible were those ventilated for over 24 hours who failed their first SBT using TP. In the extensively assisted weaning group, SBT involved PS (7 cmH2O) and PEEP (5 cmH2O); if successful, another SBT with TP followed. Failure led to post-extubation NIV, alongside other criteria. In the standard weaning group, SBT used TP, and NIV followed guidelines. The primary outcome measured the time from inclusion to successful extubation via a Cox model, adjusting for randomization strata.
The results showed 98 patients (49 in each group), with 4 patients excluded from the intention-to-treat analysis (2 in each group) ( May 2019 to March 2023). Thus, 47 patients were analyzed in both groups. The extensively assisted weaning group exhibited a higher median age (68 [58–73] vs. 62 [55–71] years) and similar gender distribution (62% male vs. 57%). No significant difference in the time to successful extubation between extensively-assisted and standard weaning groups (median, 172 [50–436] vs. 95 [47–232] hours, Cox HR for successful extubation, 0.88 [95% CI: 0.55–1.42] using the standard weaning group as a reference; P=0.60). All secondary outcomes showed no significant differences between the groups.
Investigators concluded that extensively assisted weaning with PS, SBT with PEEP, and extended NIV did not shorten extubation time compared to standard weaning.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01290-6
