A Randomized Clinical Trial to Compare the Criteria of Readiness for Extubation and Daily Spontaneous Breathing Test (SBT) on the Duration of Mechanical Ventilation

Authors

1 Department of Pediatrics, Emam Hossein children’s hospital, Isfahan University of Medical Sciences, Isfahan, Iran AND Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Department of Pediatrics, Emam Hossein children’s hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

3 Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background:  Successful weaning of the ventilator is a major challenge, especially in children. This study was conducted to compare the criteria of readiness for extubation and daily spontaneous breathing test (SBT) on the duration of mechanical ventilation and extubation failure rates.
Materials and Methods
This randomized clinical trial was conducted in the pediatric intensive care unit (PICU) of a teaching hospital (Imam Hossein Hospital) in Isfahan, Iran. Overall, 68 patients were assigned into two groups of equal number. In the intervention group, if all the readiness criteria were met the spontaneous breathing test (SPONT/PSV) was performed, and the tracheal tube was removed if the test was successful. In the control group, extubation was performed based on the physician's clinical judgment. Duration of mechanical ventilation and extubation failure rates were compared between groups.
Results: The percentage of extubation failure was higher in the control group than in the intervention (26.4% vs. 11.7%, respectively, P=0.04). The two groups were not significantly different in terms of the percentage of reintubation (11.7% vs. 5.8%), and only the percentage of using noninvasive mechanical ventilation (NIMV) was higher in controls (14.7% vs. 5.8%, respectively, P=0.05). No significant difference was observed between the two groups in terms of the median duration of mechanical ventilation in patients with successful extubation (P=0.12). Likewise, the long-term outcomes, i.e. the length of stay in PICU and hospital were not different in the two groups (P>0.05).
Conclusion
According to the results, daily SPONT/PSV test reduce extubation failure more than physician's clinical judgment in pediatric population. However, type of extubation protocol did not affect mortality, the duration of mechanical ventilation and stay in the PICU.

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