The impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: A randomized controlled trial

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dc.contributor.authorForonda, Flávia Andrea Krepel
dc.contributor.authorTroster, Eduardo Juan
dc.contributor.authorFarias, Julio A.
dc.contributor.authorBarbas, Carmen Sílvia Valente
dc.contributor.authorFerraro, Alexandre Archanjo [UNIFESP]
dc.contributor.authorFaria, Lucília Sandra Pinto de
dc.contributor.authorBousso, Albert
dc.contributor.authorPanico, Flávia Feijó
dc.contributor.authorDelgado, Artur Figueiredo
dc.contributor.institutionHosp Sirio Libanes
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.contributor.institutionHosp Albert Einstein
dc.contributor.institutionUniv Buenos Aires
dc.date.accessioned2016-01-24T14:17:25Z
dc.date.available2016-01-24T14:17:25Z
dc.date.issued2011-11-01
dc.description.abstractObjectives: To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation.Design: A prospective, randomized controlled trial.Setting: Two pediatric intensive care units at university hospitals in Brazil.Patients: the trial involved children between 28 days and 15 yrs of age who were receiving mechanical ventilation for at least 24 hrs.Interventions: Patients were randomly assigned to one of two weaning protocols. in the test group, the children underwent a daily evaluation to check readiness for weaning with a spontaneous breathing test with 10 cm H(2)O pressure support and a positive end-expiratory pressure of 5 cm H(2)O for 2 hrs. the spontaneous breathing test was repeated the next day for children who failed it. in the control group, weaning was performed according to standard care procedures.Measurements and Main Results: A total of 294 eligible children were randomized, with 155 to the test group and 139 to the control group. the time to extubation was shorter in the test group, where the median mechanical ventilation duration was 3.5 days (95% confidence interval, 3.0 to 4.0) as compared to 4.7 days (95% confidence interval, 4.1 to 5.3) in the control group (p = .0127). This significant reduction in the mechanical ventilation duration for the intervention group was not associated with increased rates of extubation failure or noninvasive ventilation. It represents a 30% reduction in the risk of remaining on mechanical ventilation (hazard ratio: 0.70).Conclusions: A daily evaluation to check readiness for weaning combined with a spontaneous breathing test reduced the mechanical ventilation duration for children on mechanical ventilation for > 24 hrs, without increasing the extubation failure rate or the need for noninvasive ventilation. (Crit Care Med 2011; 39: 2526-2533)en
dc.description.affiliationHosp Sirio Libanes, Intens Care Unit, São Paulo, Brazil
dc.description.affiliationUniv São Paulo, Sch Med, Dept Pediat, Hosp Clin, São Paulo, Brazil
dc.description.affiliationUniv São Paulo, Sch Med, Dept Pneumol, Hosp Clin, São Paulo, Brazil
dc.description.affiliationHosp Albert Einstein, Intens Care Unit, São Paulo, Brazil
dc.description.affiliationUniv Buenos Aires, Hosp Ninos R Gutierrez, Intens Care Unit, Buenos Aires, DF, Argentina
dc.description.affiliationUniv São Paulo, Sch Med, Intens Care Unit, Univ Hosp, São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Escola Paulista de Medicina (EPM)
dc.description.sourceWeb of Science
dc.format.extent2526-2533
dc.identifierhttp://dx.doi.org/10.1097/CCM.0b013e3182257520
dc.identifier.citationCritical Care Medicine. Philadelphia: Lippincott Williams & Wilkins, v. 39, n. 11, p. 2526-2533, 2011.
dc.identifier.doi10.1097/CCM.0b013e3182257520
dc.identifier.issn0090-3493
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/34207
dc.identifier.wosWOS:000296509500020
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.relation.ispartofCritical Care Medicine
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectartificialen
dc.subjectrespirationen
dc.subjectintensive care unitsen
dc.subjectpediatricsen
dc.subjectrandomized controlled trialen
dc.subjectrespiratory insufficiencyen
dc.subjectventilator weaningen
dc.titleThe impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: A randomized controlled trialen
dc.typeinfo:eu-repo/semantics/article
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