Randolph J. Lipchik, MD
In sedated patients on mechanical ventilation, are daily spontaneous awakening trials (SATs) combined with spontaneous breathing trials (SBTs) more effective for ventilator weaning than daily SBTs with sedation per usual care?
Randomized controlled trial.
4 intensive care units (ICUs) in the USA.
336 patients ≥ 18 years of age (median age 61 y, 52% men) who required mechanical ventilation for ≥ 12 hours and were receiving patient-targeted sedation. Exclusion criteria included admission after cardiac arrest, continuous ventilation for ≥ 2 weeks, and profound neurologic deficits.
Daily SAT followed by SBT (n = 168) or daily SBT with sedation per usual care (n = 168). In the SAT-plus-SBT group, patients who passed an SAT safety screen had an SAT. Patients in whom the SAT failed were restarted on sedatives at half the previous dose, and SBT was withheld; those who passed the SAT started the SBT protocol immediately. In both groups, patients who passed an SBT safety screen had an SBT. Patients in whom the SBT failed were reventilated and rescreened the next day; if the SBT was successful, the physician determined suitability for extubation.
Ventilator-free days in the first 28 days, time to discharge from ICU and hospital, self-extubation, reintubation within 48 hours, and mortality at 28 days and 1 year.
99% (intention-to-treat analysis).
SAT-plus-SBT increased number of ventilator-free days and decreased time to discharge, with increased rates of self-extubation but not reintubation (Table). Groups did not differ for 28-day mortality (28% vs 35%, P = 0.21), but 1-year mortality was lower in the SAT-plus-SBT group (44% vs 58%; hazard ratio 0.68, 95% CI 0.50 to 0.92; number needed to treat 8, CI 5 to 36).
In sedated patients on mechanical ventilation, daily spontaneous awakening trials combined with spontaneous breathing trials (SBTs) were more effective for ventilator weaning than daily SBTs with sedation per usual care.
Spontaneous awakening trial (SAT) plus spontaneous breathing trial (SBT) vs SBT with sedation per usual care for weaning sedated patients on mechanical ventilation†
†ICU = intensive care unit; CI defined in Glossary.
Lipchik RJ. Spontaneous awakening trials added to spontaneous breathing trials improved weaning from mechanical ventilation. Ann Intern Med. ;148:JC4–5. doi: 10.7326/0003-4819-148-12-200806170-02005
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Published: Ann Intern Med. 2008;148(12):JC4-5.
Emergency Medicine, Mechanical Ventilation, Pulmonary/Critical Care.
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