Higher rates of successful extubation and decreased 90-day mortality with less-demanding pressure support trial

Reference

Subira C, Hernandez G, Vazquez A, et al. Effect of pressure support vs. T-piece ventilation strategies during spontaneous breathing trials on successful extubation among patients receiving mechanical ventilation. JAMA 2019;321:2175-2182.

Synopsis

In this multicenter Spanish trial, investigators randomized adult patients using mechanical ventilation who fulfilled weaning criteria to receive 1 of 2 SBT weaning strategies: (1) a highly demanding 2-hour T-piece SBT (n = 578), or (2) a less-demanding 30-minute SBT with 8-cm H2O PSV and zero positive end-expiratory pressure (n = 575). The 2 groups had similar baseline characteristics including age, sex, APACHE II scores on admission, and duration of mechanical ventilation prior to SBT. Postextubation strategies, including prophylactic use of noninvasive ventilation or high-flow nasal cannula, were up to the discretion of the treating physician and had to be decided on prior to randomization. More patients in the PSV group achieved the primary outcome of successful extubation, defined as remaining free of mechanical ventilation for 72 hours after the first SBT, as compared with those in the T-piece group (82.3% vs 74.0%; P = .001). The PSV group also had decreased hospital mortality (10.4% vs 14.9%; P = .02; number needed to treat [NNT] = 22) and decreased 90-day mortality (13.2% vs 17.3%; P = .04; NNT = 24). There were no significant differences in reintubation rates (~ 11% in both groups), intensive care unit lengths of stay, or hospital lengths of stay.