Respiratory failure & ventilation
Effect of aggressive vs conservative screening and confirmatory test on time to extubation among patients at low or intermediate risk: a randomized clinical trial
Authors' conclusion
Among patients at low or intermediate risk for extubation failure with planned HFNC, combining aggressive screening with preventive PEEP and a conservative SBT reduced the time to extubation without increasing the reintubation rate.
Study context
- Population
- Patients with primary respiratory failure at low-to-intermediate risk for extubation failure with planned preventive high-flow nasal cannula (HFNC)analysed, ≥1 spontaneous breathing trial (SBT)
- Participants
- 884 patients
- Comparison
- Aggressive vs conservative weaning screening combined with aggressive vs conservative SBT
- Conservative-conservativen = 256reference
- Conservative-aggressiven = 267
- Aggressive-conservativen = 261
- Aggressive-aggressiven = 100
- Primary endpoint
- Time to extubation and simple weaning rate
Methodological detailsmulticentre, four-group, interim analysis
- Multicentre
- Four-group
- Interim analysis
Primary result
As reported in the abstract
Simple weaning rate and time to extubation (co-primary)
- Simple weaning rate differed across groups
- p < 0.001
- Median time to extubation lower in the groups with aggressive screening
- p < 0.001
Safety
Reintubation within 7 days after extubation
- Reintubation rates did not differ significantly
- P = 0.431
Aggressive-aggressive group
- Randomisation to the aggressive-aggressive group discontinued at the interim analysis for safety reasons
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Effect of aggressive vs conservative screening and confirmatory test on time to extubation among patients at low or intermediate risk: a randomized clinical trial. Intensive Care Med. Published 14 February 2024. doi:10.
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