EVALUATING THE EFFECT OF SCREENING FREQUENCY AND SPONTANEOUS BREATHING TRIAL METHODS ON EXTUBATION OUTCOMES: A RANDOMIZED CLINICAL TRIAL
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Keywords
Mechanical ventilation, Spontaneous breathing trial, Extubation, Critical Care, T-piece, Weaning protocol
Abstract
Background: Weaning from mechanical ventilation is a critical step in the management of critically ill patients. The frequency of screening and the technique used during spontaneous breathing trials (SBT) can influence extubation success and recovery. This study aimed to compare the effects of different screening frequencies (once-daily vs twice-daily) and SBT techniques (HFNC vs T-piece) on clinical outcomes in patients requiring invasive mechanical ventilation.
Methods: A prospective randomized clinical trial was conducted with 180 critically ill patients who were randomly assigned to one of four groups: Once-daily screening with HFNC, Once-daily screening with T-piece, Twice-daily screening with HFNC, and Twice-daily screening with T-piece. We assessed outcomes such as time to extubation, time to first successful SBT, mechanical ventilation duration, ICU stay, and reintubation rates.
Results: Twice-daily screening significantly reduced the time to extubation and the time to the first successful SBT compared to once-daily screening. The Twice-daily + HFNC group had the shortest extubation time (2.7 ± 0.9 days), and the shortest time to first successful SBT (40.2 ± 11.0 hours). Both HFNC and T-piece were effective for SBT, with HFNC showing a slight advantage in reducing time to the first successful trial. There were no significant differences in reintubation rates or ICU mortality between the groups.
Conclusion: Twice-daily screening for weaning readiness, regardless of whether HFNC or T-piece is used, leads to faster extubation and reduced mechanical ventilation duration. HFNC may offer slight advantages, but both techniques are effective. Further studies are needed to confirm these findings and assess long-term outcomes.
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Praveen Ramasamy
Assistant Professor, Dept. of Anaesthesiology, Annaii medical college and hospital, Rajalakshmi health City, Chennai
Vigneshwaran K
Assistant Professor, Dept. of Anaesthesiology & Critical Care, Panimalar medical college hospital & research institute, Chennai
Pavithra LT
Anaesthesiologist, MIOT Hospital, Chennai
Portia S
Assistant Professor, Dept. of Cardiac Anaesthesiology, Panimalar medical college hospital & research institute, Chennai