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Effect of aggressive vs conservative screening and confirmatory test on time to extubation among patients at low or intermediate risk: a randomized clinical trial.
Hernández Martínez, Gonzalo; Rodriguez, Patricia; Soto, Jesus; Caritg, Oriol; Castellví-Font, Andrea; Mariblanca, Borja; García, Antonio Maria; Colinas, Laura; Añon, Jose Manuel; Parrilla-Gomez, Francisco Jose; Silva-Obregón, Jose Alberto; Masclans, Joan Ramon; Propin, Alicia; Cuadra, Alicia; Dalorzo, Mario Guillermo; Rialp, Gemma; Suarez-Sipmann, Fernando; Roca, Oriol.
Afiliação
  • Hernández Martínez G; Complejo Hospitalario Universitario de Toledo, Toledo, Spain. ghernandezm@telefonica.net.
  • Rodriguez P; Grupo de Investigación en Disfunción y Fallo Orgánico en La Agresión (IdiPAZ), Madrid, Spain. ghernandezm@telefonica.net.
  • Soto J; Ciber Enfermedades Respiratorias (CIBERES), Health Institute Carlos III, Madrid, Spain. ghernandezm@telefonica.net.
  • Caritg O; Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
  • Castellví-Font A; Hospital Universitario La Paz, Madrid, Spain.
  • Mariblanca B; Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • García AM; Vall d'Hebron Institut de Reserca (VHIR), Barcelona, Spain.
  • Colinas L; Hospital del Mar, Barcelona, Spain.
  • Añon JM; Grupo de Investigación del Paciente Crítico (GREPAC), Institut Hospital del Mar d´Investigacions Mèdiques (IMIM), Barcelona, Spain.
  • Parrilla-Gomez FJ; Hospital Universitario de Guadalajara, Guadalajara, Spain.
  • Silva-Obregón JA; Hospital Santa Barbara, Puertollano, Spain.
  • Masclans JR; Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
  • Propin A; Hospital Universitario La Paz, Madrid, Spain.
  • Cuadra A; Grupo de Investigación en Disfunción y Fallo Orgánico en La Agresión (IdiPAZ), Madrid, Spain.
  • Dalorzo MG; Hospital del Mar, Barcelona, Spain.
  • Rialp G; Grupo de Investigación del Paciente Crítico (GREPAC), Institut Hospital del Mar d´Investigacions Mèdiques (IMIM), Barcelona, Spain.
  • Suarez-Sipmann F; Hospital Universitario de Guadalajara, Guadalajara, Spain.
  • Roca O; Grupo de Investigación del Paciente Hematológico, Instituto de Investigación Sanitaria Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
Intensive Care Med ; 50(2): 258-267, 2024 Feb.
Article em En | MEDLINE | ID: mdl-38353714
ABSTRACT

PURPOSE:

This study aimed to determine the best strategy to achieve fast and safe extubation.

METHODS:

This multicenter trial randomized patients with primary respiratory failure and low-to-intermediate risk for extubation failure with planned high-flow nasal cannula (HFNC) preventive therapy. It included four groups (1) conservative screening with ratio of partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2) ≥ 150 and positive end-expiratory pressure (PEEP) ≤ 8 cmH2O plus conservative spontaneous breathing trial (SBT) with pressure support 5 cmH2O + PEEP 0 cmH2O); (2) screening with ratio of partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2) ≥ 150 and PEEP ≤ 8 plus aggressive SBT with pressure support 8 + PEEP 5; (3) aggressive screening with PaO2/FiO2 > 180 and PEEP 10 maintained until the SBT with pressure support 8 + PEEP 5; (4) screening with PaO2/FiO2 > 180 and PEEP 10 maintained until the SBT with pressure support 5 + PEEP 0. Primary outcomes were time-to-extubation and simple weaning rate. Secondary outcomes included reintubation within 7 days after extubation.

RESULTS:

Randomization to the aggressive-aggressive group was discontinued at the interim analysis for safety reasons. Thus, 884 patients who underwent at least 1 SBT were analyzed (conservative-conservative group, n = 256; conservative-aggressive group, n = 267; aggressive-conservative group, n = 261; aggressive-aggressive, n = 100). Median time to extubation was lower in the groups with aggressive screening (p < 0.001). Simple weaning rates were 45.7%, 76.78% (205 patients), 71.65%, and 91% (p < 0.001), respectively. Reintubation rates did not differ significantly (p = 0.431).

CONCLUSION:

Among patients at low or intermediate risk for extubation failure with planned HFNC, combining aggressive screening with preventive PEEP and a conservative SBT reduced the time to extubation without increasing the reintubation rate.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Artérias / Extubação Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Artérias / Extubação Idioma: En Ano de publicação: 2024 Tipo de documento: Article