• Flávia K Foronda, Eduardo J Troster, Julio A Farias, Carmen S Barbas, Alexandre A Ferraro, Lucília S Faria, Albert Bousso, Flávia F Panico, and Artur F Delgado.
• Intensive Care Unit, Hospital Sírio Libanês, São Paulo, Brazil. flikrepel@foronda.com.br
• Crit. Care Med.. 2011 Nov 1;39(11):2526-33.

ObjectivesTo 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.DesignA prospective, randomized controlled trial.SettingTwo pediatric intensive care units at university hospitals in Brazil.PatientsThe trial involved children between 28 days and 15 yrs of age who were receiving mechanical ventilation for at least 24 hrs.InterventionsPatients 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 H2O pressure support and a positive end-expiratory pressure of 5 cm H2O 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 ResultsA 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).ConclusionsA 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.

15 keywords...

hide…