The Effect of Reconnection to Mechanical Ventilation for 1 Hour After Spontaneous Breathing Trial on Reintubation Among Patients Ventilated for More Than 12 Hours: A Randomized Clinical Trial

Abstract

The resting of the respiratory musculature after undergoing the spontaneous breathing trial (SBT) to prevent extubation failures in critically ill patients needs to be studied further. Is the reconnection to mechanical ventilation (MV) for 1h after a successful SBT able to reduce the risk of reintubation? Randomized clinical trial conducted in four ICUs between August 2018 and July 2019. Candidates for tracheal extubation who metall screening criteria for weaning were included. After achieving success in the SBT using a T-tube, the patients were randomized to the following groups: direct extubation (DE) or extubation after reconnection to MV for 1h (R1h). The primary outcome was reintubation within 48 h. Among the 336 patients studied (women, 41.1%; median age, 59 years [interquartile range, 45-70 years]), 12.9%(22/171) in the R1h group required reintubation within 48h vs18.2%(30/165) in the DE group (risk difference, 5.3 [95%CI, -2.49 to 13.12]; P= .18). No differences were found in mortality, length of ICU or hospital stay, causes of reintubation, or signs of extubation failure. A prespecified exploratory analysis showed that among the 233 patients (69.3%) who were ventilated for more than 72 h, the incidence of reintubation was 12.7%(15/118) in the R1h group compared with 22.6%(26/115) observed in the DE group (P= .04). Reconnection to MV after a successful SBT, compared with DE, did not result in a statistically significant reduction in the risk of reintubation in mechanically ventilated patients. Subgroup exploratory findings suggest that the strategy may benefit patients who were ventilated for more than 72 h, which should be confirmed in further studies. Brazilian Clinical Trials Registry; No.: RBR-3x8nxn; URL: www.ensaiosclinicos.gov.br.