{"id":26996,"date":"2024-10-18T04:04:00","date_gmt":"2024-10-17T20:04:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=26996"},"modified":"2024-10-18T06:19:39","modified_gmt":"2024-10-17T22:19:39","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e7%ad%9b%e6%9f%a5%e9%a2%91%e7%8e%87%e4%b8%8e%e8%87%aa%e4%b8%bb%e5%91%bc%e5%90%b8%e8%af%95%e9%aa%8c%e6%8a%80%e6%9c%af","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=26996","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u7b5b\u67e5\u9891\u7387\u4e0e\u81ea\u4e3b\u547c\u5438\u8bd5\u9a8c\u6280\u672f"},"content":{"rendered":"\n

Original Investigation\u00a0| Caring for the Critically Ill Patient<\/p>\n\n\n\n

October 9, 2024<\/p>\n\n\n\n

Frequency of Screening and Spontaneous Breathing Trial Techniques: A Randomized Clinical Trial<\/h1>\n\n\n\n

Karen E. A.\u00a0Burns,\u00a0Jessica\u00a0Wong,\u00a0Leena\u00a0Rizvi,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online October 9, 2024. doi:10.1001\/jama.2024.20631<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  What are the effects of alternative screening frequencies and spontaneous breathing trial (SBT) techniques on the time to successful extubation?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial with a factorial design that included 797 adults, there were no statistically significant differences between the main effects of screening frequency (once-daily vs more frequent screening) and SBT technique (pressure-supported vs T-piece SBTs). A significant interaction was identified between screening frequency and SBT technique. Successful extubation was achieved less rapidly with more frequent, compared with once-daily screening, when pressure-supported SBTs were used (hazard ratio, 0.7). Once-daily screening and pressure-supported SBTs (compared with T-piece SBTs) did not reduce the time to successful extubation (hazard ratio, 1.3).<\/p>\n\n\n\n

Meaning<\/strong>  Pressure-supported SBTs and more frequent protocolized screening increased the time to successful extubation. Additional work is needed to confirm the significant interaction between screening frequency and SBT technique and its effect on liberation from and discontinuation of mechanical ventilation.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  The optimal screening frequency and spontaneous breathing trial (SBT) technique to liberate adults from ventilators are unknown.<\/p>\n\n\n\n

Objective<\/strong>  To compare the effects of screening frequency (once-daily screening vs more frequent screening) and SBT technique (pressure-supported SBT with a pressure support level that was >0-\u22648 cm H2<\/sub>O and a positive end-expiratory pressure [PEEP] level that was >0-\u22645 cm H2<\/sub>O vs T-piece SBT) on the time to successful extubation.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Randomized clinical trial with a 2\u2009\u00d7\u20092 factorial design including critically ill adults who were receiving invasive mechanical ventilation for at least 24 hours, who were capable of initiating spontaneous breaths or triggering ventilators, and who were receiving a fractional concentration of inspired oxygen that was 70% or less and a PEEP level of 12 cm H2<\/sub>O or less. Recruitment was between January 2018 and February 2022 at 23 intensive care units in North America; last follow-up occurred October 18, 2022.<\/p>\n\n\n\n

Interventions<\/strong>  Participants were enrolled early to enable protocolized screening (more frequent vs once daily) to identify the earliest that patients met criteria to undergo pressure-supported or T-piece SBT lasting 30 to 120 minutes.<\/p>\n\n\n\n

Main Outcome and Measures<\/strong>  Time to successful extubation (time when unsupported, spontaneous breathing began and was sustained for \u226548 hours after extubation).<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Of 797 patients (198 in the once-daily screening and pressure-supported SBT group, 204 in once-daily screening and T-piece SBT, 195 in more frequent screening and pressure-supported SBT, and 200 in more frequent screening and T-piece SBT), the mean age was 62.4 (SD, 18.4) years and 472 (59.2%) were men. There were no statistically significant differences by screening frequency (hazard ratio [HR], 0.88 [95% CI, 0.76-1.03];\u00a0P<\/em>\u2009=\u2009.12) or by SBT technique (HR, 1.06 [95% CI, 0.91-1.23];\u00a0P<\/em>\u2009=\u2009.45). The median time to successful extubation was 2.0 days (95% CI, 1.7-2.7) for once-daily screening and pressure-supported SBT, 3.1 days (95% CI, 2.7-4.8) for once-daily screening and T-piece SBT, 3.9 days (95% CI, 2.9-4.7) for more frequent screening and pressure-supported SBT, and 2.9 days (95% CI, 2.0-3.1) for more frequent screening and T-piece SBT. An unexpected interaction between screening frequency and SBT technique required pairwise contrasts that revealed more frequent screening (vs once-daily screening) and pressure-supported SBT increased the time to successful extubation (HR, 0.70 [95% CI, 0.50-0.96];\u00a0P<\/em>\u2009=\u2009.02). Once-daily screening and pressure-supported SBT (vs T-piece SBT) did not reduce the time to successful extubation (HR, 1.30 [95% CI, 0.98-1.70];\u00a0P<\/em>\u2009=\u2009.08).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Among critically ill adults who received invasive mechanical ventilation for more than 24 hours, screening frequency (once-daily vs more frequent screening) and SBT technique (pressure-supported vs T-piece SBT) did not change the time to successful extubation. However, an unexpected and statistically significant interaction was identified; protocolized more frequent screening combined with pressure-supported SBTs increased the time to first successful extubation.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifiers: NCT02399267<\/a> and NCT02969226<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation\u00a0| Caring for the Critically Ill […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26996"}],"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=26996"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26996\/revisions"}],"predecessor-version":[{"id":26997,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26996\/revisions\/26997"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26996"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26996"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26996"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}