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Treatment
Spontaneous awakening trials plus spontaneous breathing trials improved weaning from mechanical ventilation

https://doi.org/10.1136/ebn.11.3.81

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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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    Footnotes

    • Source of funding: Saint Thomas Foundation; National Institutes of Health; Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center.