Frequency of Screening and Spontaneous Breathing Trial Techniques: A Randomized Clinical Trial.

Journal

JAMA
ISSN: 1538-3598
Titre abrégé: JAMA
Pays: United States
ID NLM: 7501160

Informations de publication

Date de publication:
09 Oct 2024
Historique:
medline: 9 10 2024
pubmed: 9 10 2024
entrez: 9 10 2024
Statut: aheadofprint

Résumé

The optimal screening frequency and spontaneous breathing trial (SBT) technique to liberate adults from ventilators are unknown. 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 H2O and a positive end-expiratory pressure [PEEP] level that was >0-≤5 cm H2O vs T-piece SBT) on the time to successful extubation. 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 H2O 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. 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. Time to successful extubation (time when unsupported, spontaneous breathing began and was sustained for ≥48 hours after extubation). 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 pressure-supported SBT, 3.1 days (95% CI, 2.7-4.8) for once-daily screening and T-piece SBT, 3.9 days (95% CI, 2.9-4.7) for more frequent screening and pressure-supported SBT, and 2.9 days (95% CI, 2.0-3.1) for more frequent screening and T-piece SBT. An unexpected interaction between screening frequency and SBT technique required pairwise contrasts that revealed more frequent screening (vs once-daily screening) and pressure-supported SBT increased the time to successful extubation (HR, 0.70 [95% CI, 0.50-0.96]; P = .02). Once-daily screening and pressure-supported SBT (vs T-piece SBT) did not reduce the time to successful extubation (HR, 1.30 [95% CI, 0.98-1.70]; P = .08). Among critically ill adults who received invasive mechanical ventilation for more than 24 hours, screening frequency (once-daily vs more frequent screening) and SBT technique (pressure-supported vs T-piece SBT) did not change the time to successful extubation. However, an unexpected and statistically significant interaction was identified; protocolized more frequent screening combined with pressure-supported SBTs increased the time to first successful extubation. ClinicalTrials.gov Identifiers: NCT02399267 and NCT02969226.

Identifiants

DOI: 10.1001/jama.2024.20631 PMID: 39382222
pubmed: 39382222
pii: 2824928
doi: 10.1001/jama.2024.20631
doi:

Banques de données

ClinicalTrials.gov
['NCT02399267', 'NCT02969226']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Investigateurs

Kim Dawdy (K)
Zana Mariano (Z)
Gyan Sandhu (G)
Marlene Santos (M)
Imrana Khalid (I)
Kurtis Salway (K)
Jennifer Hodder (J)
Orla Smith (O)
Jessica Hajj (J)
Samantha Buchanan (S)
Vivianne Severdija (V)
Anna Medvetskaya (A)
Sarah Enriquez (S)
John Michaels (J)
Kanthi Kavikondala (K)
Irene Watpool (I)
Rebecca Porteous (R)
Kaitlyn Montroy (K)
Sydney Miezitis (S)
Jessica Haines (J)
Heather Langlois (H)
Jackie Bastianon (J)
Saba Rawjani (S)
Aaron Nesom (A)
Brigette Gomes (B)
Liane Leclair (L)
Jay Greco (J)
Marie-Hélène Masse (MH)
Joannie Marchand (J)
Marie-Pier Bouchard (MP)
Elaine Carbonneau (E)
Julie Belisle (J)
Marilène Ladouceur (M)
Karine Grondin (K)
France Clarke (F)
Neala Hoad (N)
Timothy Karachi (T)
Tina Millen (T)
Jennifer Leroux (J)
Jean-Francois Naud (JF)
Isabelle Roy (I)
Martin Faucher (M)
Mélissa Bellefeuille (M)
Danielle Tapps Tapps (DT)
Mylena Laplante (M)
Cassandra Mailloux (C)
Lea Durocher (L)
Martine Lebrasseur (M)
Marie-Eve Cantin (ME)
Dounia Boumahni (D)
Fatna Benettaib Benettaib (FB)
Ali Ghamraoui (A)
Maya Salamé (M)
Karine-Candy Gagnon (KC)
David Bellemare (D)
Joannie Blais (J)
Marie-Claude Boulanger (MC)
Eve Cloutier (E)
Olivier Costerousse (O)
Hélène Côté (H)
Emilie Couillard-Chénard (E)
Marjorie Daigle (M)
Charles Francoeur (C)
Gabrielle Guilbault (G)
Stéphanie Grenier (S)
Francois Lauzier (F)
Guillaume Leblanc (G)
Shany Rodrigue (S)
Isabelle St Hilaire (I)
Maude St Onge (M)
Antoine Tremblay (A)
Patrica Thompson (P)
Tayne Hewer (T)
Cynthia Smit (C)
Victoria Alcuaz (V)
Lena Farina (L)
Draga Jichici (D)
Lori Hand (L)
Claudia Poulin (C)
Erick Duan (E)
Mercedes Camargo-Penuela (M)
Lisa Patterson (L)
Jeremy Yue (J)
Anthony Tj Fuagno (AT)
Mary M Hayes (MM)
Abigail Pires (A)
Grace Kersker (G)
Fernando Martinez Guasch (F)
Adriana Paz Mancia (A)
Courtney Capobianco (C)
Leslie Lussier (L)
Hyunsoon Park (H)
Kelvin Arreola (K)
Kenneth Le (K)
Son Nguyen (S)
Kristi Peters-Fitzpatrick (K)
Amy Blank (A)
Joshua Cosa (J)
Arin Marshall (A)
Cedrik De La Pena (C)
Francine McGonagle (F)
Shubhra Srivastava-Malhotra (S)
Sheril George (S)
Heidi Shore-Brown (H)
Lauren Miller (L)
Linda Ayres (L)
David Miller (D)
Kristine Nelson (K)
Carl Haas (C)
Jose Victor Jimenez (JV)
Andy Weirauch (A)
Alexis Serra (A)
Ivan Garcia (I)
Charmaine Wilson (C)
Valerie Goodspeed (V)
Julia Dwyer Crane (J)
Andrew Toksoz-Exley (A)
Krystal Capers (K)
Andre De Souza Licht (A)
Lynn Fukushima (L)
Carese Lee (C)
Daniel Motamedi (D)
Thelma Harrington (T)
Olga Kolesnik (O)
Maura Deeley (M)

Auteurs

Karen E A Burns (KEA)

Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
Department of Critical Care, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.
Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Jessica Wong (J)

University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada.

Leena Rizvi (L)

Department of Critical Care, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.

Myriam Lafreniere-Roula (M)

Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.

Kevin Thorpe (K)

Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.
University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada.

John W Devlin (JW)

Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts.
Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Deborah J Cook (DJ)

Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Departments of Medicine and Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Andrew Seely (A)

Department of Critical Care, Ottawa Hospital, Ottawa, Ontario, Canada.
Division of Thoracic Surgery, Department of Surgery and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.

Peter M Dodek (PM)

Division of Critical Care Medicine and Center for Advancing Health Outcomes, St Paul's Hospital, Vancouver, British Columbia, Canada.
University of British Columbia, Vancouver, Canada.

Maged Tanios (M)

Division of Pulmonary and Critical Care Medicine, University of California, Irvine.
Pulmonary and Critical Care, Memorial Care, Long Beach Medical Center, Long Beach, California.

Thomas Piraino (T)

Department of Critical Care, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.
Departments of Medicine and Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Audrey Gouskos (A)

Patient and Family Advisory Committee of the Frequency of Screening and Spontaneous Breathing Trial Technique Trial, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.

Kenneth C Kiedrowski (KC)

Patient and Family Advisory Committee of the Frequency of Screening and Spontaneous Breathing Trial Technique Trial, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.

Phyllis Kay (P)

Patient and Family Advisory Committee of the Frequency of Screening and Spontaneous Breathing Trial Technique Trial, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.

Susan Mitchell (S)

Patient and Family Advisory Committee of the Frequency of Screening and Spontaneous Breathing Trial Technique Trial, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.

George W Merner (GW)

Patient and Family Advisory Committee of the Frequency of Screening and Spontaneous Breathing Trial Technique Trial, Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.

Michael Mayette (M)

Departments of Medicine and Anesthesia, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.

Frederick D'Aragon (F)

Departments of Medicine and Anesthesia, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.

Francois Lamontagne (F)

Departments of Medicine and Anesthesia, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.

Bram Rochwerg (B)

Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Departments of Medicine and Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Alexis Turgeon (A)

Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada.
Population Health and Optimal Health Practice Research Unit, Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, Quebec, Canada.

Ying Tung Sia (YT)

Department of Medicine, Centre Intégré Universitaire en Santé et Services Sociaux Rivières de la Mauricie-et-du-Centre-du Québec, Trois-Rivières, Quebec, Canada.

Emmanuel Charbonney (E)

Department of Medicine, University of Montreal, Montreal, Quebec, Canada.
Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.

Pierre Aslanian (P)

Department of Medicine, University of Montreal, Montreal, Quebec, Canada.
Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.

Gerard J Criner (GJ)

Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.

Robert C Hyzy (RC)

Division of Pulmonary and Critical Care Medicine, Department of Medicine; University of Michigan, Ann Arbor.

Jeremy R Beitler (JR)

Center for Acute Respiratory Failure and Department of Internal Medicine, Columbia University, New York, New York.

Elias Baedorf Kassis (EB)

School of Medicine, Harvard University, Boston, Massachusetts.
Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Demetrios James Kutsogiannis (DJ)

Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.

Maureen O Meade (MO)

Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Departments of Medicine and Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Department of Critical Care, Hamilton Health Sciences, Hamilton, Ontario, Canada.

Janice Liebler (J)

Division of Pulmonary, Critical Care and Medicine, Keck School of Medicine, University of Southern California, Los Angeles.

Santhi Iyer-Kumar (S)

Division of Pulmonary, Critical Care and Medicine, Keck School of Medicine, University of Southern California, Los Angeles.

Jennifer Tsang (J)

Departments of Medicine and Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Niagara Health Knowledge Institute, Niagara Health, St Catharines, Ontario, Canada.

Robert Cirone (R)

Divisions of Critical Care and Anesthesia, Unity Health Toronto-St Joseph's Hospital, Toronto, Ontario, Canada.

Carl Shanholtz (C)

Department of Medicine and Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Maryland, Baltimore.

Nicholas S Hill (NS)

Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts.

Classifications MeSH