Reconnect
Trial question
What is the effect of a 1-hour rest after a successful spontaneous breathing trial in critically ill patients?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 470
470 patients (168 female, 302 male).
Inclusion criteria: ICU patients under mechanical ventilation for > 12 hours who fulfilled criteria for planned extubation.
Key exclusion criteria: age < 18 years; tracheostomy; overwhelming respiratory secretions; inability to follow commands; DNR or do-not-reintubate orders; out-of-protocol extubation; formal indication for noninvasive ventilation after extubation.
Interventions
N=227 1-hour rest (reconnection to the ventilator for a 1-hour rest before extubation after a successful spontaneous breathing trial).
N=243 direct extubation (direct extubation after a successful spontaneous breathing trial).
Primary outcome
Re-intubation within 48 hours
5%
14%
14.0 %
10.5 %
7.0 %
3.5 %
0.0 %
1-hour
rest
Direct
extubation
Significant
decrease ▼
NNT = 11
Significant decrease in re-intubation within 48 hours (5% vs. 14%; OR 0.33, 95% CI 0.16 to 0.65).
Secondary outcomes
Significant decrease in post-extubation respiratory failure within 48 hours (10% vs. 24%; OR 0.35, 95% CI 0.21 to 0.61).
No significant difference in length of ICU stay (11 days vs. 10 days; AD 1 days, 95% CI -0.88 to 2.88).
No significant difference in length of hospital stay (26 days vs. 23 days; AD 3 days, 95% CI -58.35 to 64.35).
Safety outcomes
No significant difference in death.
Significant difference in extubation failure in high-risk patients (12% vs. 25%) and re-intubation within 48 hours in high-risk patients (6% vs. 16%).
Conclusion
In ICU patients under mechanical ventilation for > 12 hours who fulfilled criteria for planned extubation, 1-hour rest was superior to direct extubation with respect to a re-intubation within 48 hours.
Reference
M Mar Fernandez, Alejandro González-Castro, Monica Magret et al. Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial. Intensive Care Med. 2017 Nov;43(11):1660-1667.
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