The effect of reconnection to mechanical ventilation for 1 hour after spontaneous breathing trial on reintubation among patients ventilated for more than 12 hours: A randomized clinical trial.

ABSTRACT Background The rest of the respiratory musculature after the spontaneous breathing test to prevent extubation failures in critically ill patients needs to be further studied. Research Question Is the reconnection to mechanical ventilation (MV) for 1 hour after a successful spontaneous breathing trial (SBT) able to reduce the risk of reintubation? Study Design and Methods Randomized clinical trial conducted in four intensive care units (ICUs) between August 2018 and July 2019. Candidates for tracheal extubation who met all screening criteria for weaning were included. Once successful in the SBT using a T-tube, the patients were randomized to the following groups: direct extubation (DE) or extubation after reconnection to MV for 1 hour (R1h). The primary outcome was reintubation within 48 hours. Results Among the 336 patients studied (female, 41.1%; median age, 59 [45 – 70] years), 12.9% (22/171) in the R1h group required reintubation within 48 hours versus 18.2% (30/165) in the DE group (risk difference [RD] 5.3 [95% CI: -2.49-13.12; p=0.18). There were no differences in mortality, length of ICU or hospital stay, causes of reintubation, or signs of extubation failure. A prespecified exploratory analysis showed that among the 233 (69.3%) patients who were ventilated for more than 72 hours, the incidence of reintubation was 12.7% (15/118) in the R1h group compared to 22.6% (26/115) observed in the DE group (p=0.04). Interpretation Reconnection to MV after a successful SBT, compared with DE, did not result in a statistically significant reduction in the risk of reintubation in mechanically ventilated patients. Subgroup exploratory findings suggest that the strategy may benefit patients who were ventilated for more than 72 hours, which should be confirmed in further studies.