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Spontaneous awakening trials plus spontaneous breathing trials improved weaning from mechanical ventilationCommentary

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T D Girard

Dr T D Girard, Vanderbilt University School of Medicine, Nashville, TN, USA; timothy.girard@vanderbilt.edu

QUESTION

In sedated patients on mechanical ventilation, are daily spontaneous awakening trials (SATs) combined with spontaneous breathing trials (SBTs) more effective for ventilator weaning than daily SBTs with sedation per usual care?

METHODS

Design:

randomised controlled trial.

Allocation:

concealed.

Blinding:

unblinded.

Follow-up period:

1 year.

Setting:

4 medical intensive care units (ICUs) in the USA.

Patients:

336 patients ⩾18 years of age (median age 61 y, 52% men) who required mechanical ventilation for ⩾12 hours and were receiving patient-targeted sedation. Exclusion criteria included admission after cardiac arrest, continuous ventilation for ⩾2 weeks, and profound neurological deficits.

Intervention:

daily SAT followed by SBT (n = 168) or daily SBT with sedation per usual care (n = 168). In the SAT + SBT group, patients who passed an SAT safety screen had an SAT. Patients who failed the SAT were restarted on sedatives at half …

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