Spontaneous Breathing Trial for Prediction of Extubation Success in Pediatric Patients Following Congenital Heart Surgery: A Randomized Controlled Trial*
Spontaneous Breathing Trial for Prediction of Extubation Success in Pediatric Patients Following Congenital Heart Surgery: A Randomized Controlled Trial*
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DOI：
10.1097/pcc.0000000000002006
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发表时间：
2019-10-01
影响因子：
4.1
通讯作者：
Carlotti, Ana P. C. P.
中科院分区：
文献类型：
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作者：
Ferreira, Felipe V.;Sugo, Edward K.;Carlotti, Ana P. C. P.
目的：评价与医生引导的撤机相比，自主呼吸试验在预测儿科患者心脏手术后拔管成功率方面的有效性。研究设计：随机对照试验。设置：三级保健大学医院的PICU。患者：先天性心脏病心脏手术后的儿科患者人群。干预措施：将术后机械通气超过12小时且认为已准备好脱机的患者随机分配至自主呼吸试验组或对照组。自主呼吸试验在持续气道正压下进行，压力支持为10 cmH 2 O，呼气末正压为5 cmH 2 O，吸入氧分数小于或等于0.5，持续2 h。对照组根据临床判断撤机。测量和主要结果：主要终点是拔管成功，定义为拔管后48小时内不需要重新插管。次要结局为PICU住院时间、住院时间、呼吸机相关性肺炎发生率和死亡率。110例中位年龄为8个月的患者被纳入研究：56例被分配到自主呼吸试验组，54例被分配到对照组。两组的人口统计学和临床数据以及先天性心脏手术风险调整-1分类相似。与对照组相比，接受自主呼吸试验的患者拔管成功率更高（83% vs 68%，p = 0.02），PICU住院时间更短（中位数85 vs 367小时，p < 0.0001）。两组患者的住院时间、呼吸机相关性肺炎发生率和死亡率无显著差异。结论：与根据临床判断断奶的先天性心脏病患儿相比，接受术后自主呼吸试验的患儿拔管成功率更高，PICU住院时间更短。
Objectives: To evaluate the usefulness of a spontaneous breathing trial for predicting extubation success in pediatric patients in the postoperative period after cardiac surgery compared with a physician-led weaning. Study Design: Randomized, controlled trial. Setting: PICU of a tertiary-care university hospital. Patients: A population of pediatric patients following cardiac surgery for congenital heart disease. Interventions: Patients on mechanical ventilation for more than 12 hours after surgery who were considered ready for weaning were randomized to the spontaneous breathing trial group or the control group. The spontaneous breathing trial was performed on continuous positive airway pressure with the pressure support of 10 cmH(2)O, the positive end-expiratory pressure of 5 cmH(2)O, and the fraction of inspired oxygen less than or equal to 0.5 for 2 hours. Patients in the control group underwent ventilator weaning according to clinical judgment. Measurements and Main Results: The primary endpoint was extubation success defined as no need for reintubation within 48 hours after extubation. Secondary outcomes were PICU length of stay, hospital length of stay, occurrence rate of ventilator-associated pneumonia, and mortality. One hundred and ten patients with the median age of 8 months were included in the study: 56 were assigned to the spontaneous breathing trial group and 54 were assigned to the control group. Demographic and clinical data and Risk Adjustment for Congenital Heart Surgery-1 classification were similar in both groups. Patients undergoing the spontaneous breathing trial had greater extubation success (83% vs 68%, p = 0.02) and shorter PICU length of stay (median 85 vs 367 hr, p < 0.0001) compared with the control group, respectively. There was no significant difference between groups in hospital length of stay, occurrence rate of ventilator-associated pneumonia, and mortality. Conclusions: Pediatric patients with congenital heart disease undergoing the spontaneous breathing trial postoperatively had greater extubation success and shorter PICU length of stay compared with those weaned according to clinical judgment.