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Am. J. Respir. Crit. Care Med., Volume 159, Number 2, February 1999, 512-518

Effect of Spontaneous Breathing Trial Duration on Outcome of Attempts to Discontinue Mechanical Ventilation

ANDRÉS ESTEBAN, INMACULADA ALÍA, MARTIN J. TOBIN, ANSELMO GIL, FEDERICO GORDO, INMACULADA VALLVERDÚ, LLUIS BLANCH, ALFONSO BONET, ANTONIA VÁZQUEZ, RAUL de PABLO, ANTONIO TORRES, MIGUEL A. de la CAL, and SANTIAGO MACÍAS*

Hospital Universitario de Getafe, Madrid; Hospital General, Jerez de la Frontera; Hospital de la Santa Cruz y San Pablo, Hospital del Mar, and Hospital Clínico, Barcelona; Hospital Parc Taulí, Sabadell; Hospital Josep Trueta, Gerona; Hospital Príncipe de Asturias, Alcalá de Henares; Hospital General, Segovia, Spain; Loyola University, Chicago; and Hines Veterans Affairs Hospital, Hines, Illinois

The duration of spontaneous breathing trials before extubation has been set at 2 h in research studies, but the optimal duration is not known. We conducted a prospective, multicenter study involving 526 ventilator-supported patients considered ready for weaning, to compare clinical outcomes for trials of spontaneous breathing with target durations of 30 and 120 min. Of the 270 and 256 patients in the 30- and 120-min trial groups, respectively, 237 (87.8%) and 216 (84.8%), respectively, completed the trial without distress and were extubated (p = 0.32); 32 (13.5%) and 29 (13.4%), respectively, of these patients required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after a spontaneous breathing trial did not differ in the 30- and 120-min trial groups (75.9% versus 73.0%, respectively, p = 0.43). The 30- and 120-min trial groups had similar within-unit mortality rates (13 and 9%, respectively) and in-hospital mortality rates (19 and 18%, respectively). Reintubation was required in 61 (13.5%) patients, and these patients had a higher mortality (20 of 61, 32.8%) than did patients who tolerated extubation (18 of 392, 4.6%) (p < 0.001). Neither measurements of respiratory frequency, heart rate, systolic blood pressure, and oxygen saturation during the trial, nor other functional measurements before the trial discriminated between patients who required reintubation from those who tolerated extubation. In conclusion, after a first trial of spontaneous breathing, successful extubation was achieved equally effectively with trials targeted to last 30 and 120 min.




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