{"id":17912,"date":"2019-12-06T05:25:16","date_gmt":"2019-12-05T21:25:16","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17912"},"modified":"2019-12-12T07:09:51","modified_gmt":"2019-12-11T23:09:51","slug":"jama%e4%bd%9c%e8%80%85%e5%9b%9e%e5%a4%8d%ef%bc%9a%e8%87%aa%e4%b8%bb%e5%91%bc%e5%90%b8%e8%af%95%e9%aa%8c%e4%b8%8e%e6%88%90%e5%8a%9f%e6%8b%94%e7%ae%a1","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17912","title":{"rendered":"[JAMA\u4f5c\u8005\u56de\u590d]\uff1a\u81ea\u4e3b\u547c\u5438\u8bd5\u9a8c\u4e0e\u6210\u529f\u62d4\u7ba1"},"content":{"rendered":"\n<p>Comment &amp; Response&nbsp;November&nbsp;5,&nbsp;2019<\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Spontaneous Breathing Trials and Successful Extubation\u2014Reply<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Carles&nbsp;Subir\u00e0,&nbsp;Rafael&nbsp;Fern\u00e1ndez<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><em>JAMA.&nbsp;<\/em>2019;322(17):1717. doi:10.1001\/jama.2019.14244<\/h3>\n\n\n\n<p><strong>In Reply<\/strong><\/p>\n\n\n\n<p>We agree with Drs Friedrich and Burns that prophylaxis against postextubation respiratory failure with NIV or HFNC was more common in the PSV group than in the T-piece group (24.7% vs 18.7%).<sup><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2753890#jlr190086r1\">1<\/a><\/sup>\u00a0However, the decision to apply prophylaxis was made before randomization, so this difference can only be attributed to chance. We would like to clarify that patients could receive prophylactic NIV or HFNC but not both.<\/p>\n\n\n\n<p>\u6211\u4eec\u540c\u610fFriedrich \u548c Burns \u533b\u751f\u7684\u610f\u89c1\uff0c\u5373NIV\u6216HFNC\u9884\u9632\u62d4\u7ba1\u540e\u547c\u5438\u529f\u80fd\u8870\u7aed\u5728PSV\u7ec4\u8f83T\u7ba1\u7ec4\u66f4\u591a (24.7% vs 18.7%)\u3002\u7136\u800c\uff0c\u662f\u5426\u4f7f\u7528\u4e0a\u8ff0\u9884\u9632\u63aa\u65bd\u662f\u5728\u968f\u673a\u5316\u4e4b\u524d\u4f5c\u51fa\u7684\u51b3\u5b9a\uff0c\u56e0\u6b64\uff0c\u8fd9\u4e00\u5dee\u5f02\u4ec5\u56e0\u5076\u7136\u9020\u6210\u3002\u6211\u4eec\u8fd8\u60f3\u6f84\u6e05\uff0c\u60a3\u8005\u53ef\u4ee5\u4f7f\u7528\u9884\u9632\u6027NIV\u6216HFNC\uff0c\u4f46\u4e0d\u80fd\u4e24\u8005\u5747\u4f7f\u7528\u3002<\/p>\n\n\n\n<p>In response to their question about the rate of NIV and HFNC to treat postextubation respiratory failure in each group, postextubation respiratory failure occurred in 213 patients (20.9%): 103 in the T-piece group (21.2%) and 110 in the PSV group (20.7%) (<em>P<\/em>\u2009=\u2009.84). In patients with postextubation respiratory failure, NIV was applied in 43 patients in the T-piece group (41.7%) and in 48 patients in the PSV group (43.6%) (<em>P<\/em>\u2009=\u2009.78), and HFNC was applied in 28 patients in the T-piece group (27.2%) and in 19 patients (17.3%) in the PSV group (<em>P<\/em>\u2009=\u2009.08). Four patients in each group received both treatments (3.9% in the T-piece group and 3.6% in the PSV group;\u00a0<em>P<\/em>\u2009=\u2009.92). These results reinforce the idea that the higher rate of successful extubation in PSV was due to better tolerance of the SBT, with similar rates of respiratory failure and reintubation in the 2 groups. Prophylactic treatment did not seem to influence the main result of the study.<\/p>\n\n\n\n<p>\u6709\u5173\u5404\u7ec4\u4f7f\u7528NIV\u548cHFNC\u6cbb\u7597\u62d4\u7ba1\u540e\u547c\u5438\u529f\u80fd\u8870\u7aed\u7684\u6bd4\u4f8b\u8fd9\u4e00\u95ee\u9898\uff0c\u62d4\u7ba1\u540e\u5171213\u4f8b\u60a3\u8005\u53d1\u751f\u547c\u5438\u529f\u80fd\u8870\u7aed(20.9%)\uff1aT\u7ba1\u7ec4103\u4f8b (21.2%)\uff0cPSV\u7ec4110\u4f8b (20.7%) (<em>P<\/em>\u2009=\u2009.84)\u3002\u5728\u62d4\u7ba1\u540e\u53d1\u751f\u547c\u5438\u8870\u7aed\u7684\u60a3\u8005\u4e2d\uff0cT\u7ba1\u7ec4\u548cPSV\u7ec4\u5206\u522b\u670943\u4f8b (41.7%) \u548c 48\u4f8b  (43.6%) \u4f7f\u7528\u4e86NIV (<em>P<\/em>\u2009=\u2009.78)\uff0c\u5206\u522b\u670928 \u4f8b (27.2%) \u548c 19 \u4f8b (17.3%) \u4f7f\u7528\u4e86HFNC (<em>P<\/em>\u2009=\u2009.08)\u3002\u6bcf\u7ec4\u5404\u67094\u540d\u60a3\u8005\u63a5\u53d7NIV\u548cHFNC (T\u7ba1\u7ec43.9%\uff0cPSV\u7ec43.6%\uff1b<em>P<\/em>\u2009=\u2009.92)\u3002\u8fd9\u4e9b\u7ed3\u679c\u5f3a\u8c03\u4e00\u4e0b\u89c2\u70b9\uff0c\u5373PSV\u7ec4\u6210\u529f\u62d4\u7ba1\u7387\u8f83\u9ad8\u662f\u7531\u4e8eSBT\u66f4\u597d\u7684\u8010\u53d7\u6027\uff0c\u800c\u4e24\u7ec4\u95f4\u547c\u5438\u8870\u7aed\u548c\u518d\u63d2\u7ba1\u7387\u76f8\u4f3c\u3002\u9884\u9632\u6027\u6cbb\u7597\u63aa\u65bd\u5e76\u672a\u5f71\u54cd\u7814\u7a76\u7684\u4e3b\u8981\u7ed3\u679c\u3002<\/p>\n\n\n\n<p>Dr Mancebo and colleagues point out that our results would be expected based on Bayes\u2019 theorem; however, our study demonstrated that these predictions hold true in real-life routine clinical scenarios. The high percentage of patients who tolerated the SBT merely reflects that most physicians routinely wait for patients to fully recover before subjecting them to an SBT; importantly, even in these conditions, 30 minutes of PSV seems better than a 2-hour T-piece SBT. Whether physicians should perform SBTs earlier remains open to investigation.<\/p>\n\n\n\n<p>Mancebo\u533b\u751f\u53ca\u5176\u540c\u4e8b\u6307\u51fa\uff0c\u6839\u636eBayes\u5b9a\u7406\u53ef\u4ee5\u9884\u89c1\u5230\u6211\u4eec\u7684\u7ed3\u679c\uff1b\u7136\u800c\uff0c\u6211\u4eec\u7684\u7814\u7a76\u663e\u793a\uff0c\u8fd9\u4e9b\u9884\u6d4b\u5728\u771f\u5b9e\u751f\u6d3b\u4e2d\u5e38\u89c4\u4e34\u5e8a\u72b6\u51b5\u4e0b\u4e5f\u662f\u6b63\u786e\u7684\u3002\u8010\u53d7SBT\u60a3\u8005\u6bd4\u4f8b\u5f88\u9ad8\uff0c\u8fd9\u4e00\u70b9\u4ec5\u4ec5\u53cd\u6620\u4e86\u591a\u6570\u533b\u751f\u5e38\u89c4\u7b49\u5f85\u60a3\u8005\u5b8c\u5168\u6062\u590d\uff0c\u518d\u8fdb\u884cSBT\uff1b\u91cd\u8981\u7684\u662f\uff0c\u5373\u4f7f\u5728\u8fd9\u79cd\u60c5\u51b5\u4e0b\uff0c30\u5206\u949fPSV\u4ecd\u7136\u4f18\u4e8e2\u5c0f\u65f6T\u7ba1SBT\u3002\u533b\u751f\u662f\u5426\u5e94\u5f53\u66f4\u65e9\u8fdb\u884cSBT\u6709\u5f85\u7814\u7a76\u3002<\/p>\n\n\n\n<p>Their comments about the possible effects of the interim analysis on the meaning of our findings are based on a misunderstanding. Our sentence \u201c\u2026a prespecified interim analysis was performed\u2026showed a nonsignificant difference in primary outcome between groups\u2026\u201d only referred to the fact that due to the sample size, the observed difference between groups (SBT tolerance, 82.5% vs 74.2%;\u00a0<em>P<\/em>\u2009=\u2009.02) did not reach the prespecified statistical significance level for stopping the trial. To dispel suspicion about possible behavioral changes after the interim analysis, we would like to clarify that the size of the effect was similar in the periods before and after the analysis.<\/p>\n\n\n\n<p>\u4ed6\u4eec\u6709\u5173\u4e2d\u671f\u5206\u6790\u5bf9\u7814\u7a76\u7ed3\u679c\u53ef\u80fd\u4ea7\u751f\u7684\u5f71\u54cd\u662f\u56e0\u8bef\u89e3\u5bfc\u81f4\u7684\u3002\u6211\u4eec\u7684\u539f\u8bdd\u201c...\u8fdb\u884c\u4e86\u9884\u5148\u786e\u5b9a\u7684\u4e2d\u671f\u5206\u6790...\u7ed3\u679c\u663e\u793a\uff0c\u4e24\u7ec4\u95f4\u4e3b\u8981\u9884\u540e\u6307\u6807\u6ca1\u6709\u663e\u8457\u5dee\u5f02...\u7814\u7a76\u8005\u51b3\u5b9a\u5b8c\u6210\u9884\u8ba1\u7684\u6837\u672c\u91cf\u201d\u4ec5\u4ec5\u6307\u4ee5\u4e0b\u4e8b\u5b9e\uff0c\u5373\u7531\u4e8e\u6837\u672c\u91cf\u7684\u539f\u56e0\uff0c\u89c2\u5bdf\u5230\u7684\u7ec4\u95f4\u5dee\u5f02(SBT \u8010\u53d7\u6027, 82.5% vs 74.2%;\u00a0<em>P<\/em>\u2009=\u2009.02) \u6ca1\u6709\u8fbe\u5230\u9884\u5148\u786e\u5b9a\u7684\u7ec8\u6b62\u8bd5\u9a8c\u6240\u9700\u7684\u7edf\u8ba1\u5b66\u663e\u8457\u5dee\u5f02\u6c34\u5e73\u3002\u4e3a\u6d88\u9664\u4e2d\u671f\u5206\u6790\u540e\u7814\u7a76\u884c\u4e3a\u53d1\u751f\u6539\u53d8\u7684\u53ef\u80fd\u7591\u8651\uff0c\u6211\u4eec\u5e0c\u671b\u6307\u51fa\uff0c\u5728\u4e2d\u671f\u5206\u6790\u524d\u540e\u9636\u6bb5\u7684\u7597\u6548\u662f\u76f8\u4f3c\u7684\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Comment &amp; Response&nbsp;November&nbsp;5,&nbsp;2019  [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17912"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17912"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17912\/revisions"}],"predecessor-version":[{"id":17998,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17912\/revisions\/17998"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17912"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17912"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17912"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}