All authors: Department of Pediatrics, Division of Pediatric Critical Care, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Pediatr Crit Care Med. 2019 Oct;20(10):940-946. doi: 10.1097/PCC.0000000000002006.
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.
Randomized, controlled trial.
PICU of a tertiary-care university hospital.
A population of pediatric patients following cardiac surgery for congenital heart disease.
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 cmH2O, the positive end-expiratory pressure of 5 cmH2O, 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.
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.
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.
评估自主呼吸试验在预测心脏手术后儿科患者拔管成功方面的有用性，与医生主导的撤机相比。
随机对照试验。
三级大学医院的 PICU。
先天性心脏病心脏手术后接受机械通气超过 12 小时且被认为准备撤机的儿科患者。
对连续正压通气患者进行自主呼吸试验，压力支持为 10cmH2O，呼气末正压为 5cmH2O，吸氧分数小于或等于 0.5，持续 2 小时。对照组患者根据临床判断进行呼吸机撤机。
主要终点为拔管成功，定义为拔管后 48 小时内无需再次插管。次要结局为 PICU 住院时间、总住院时间、呼吸机相关性肺炎发生率和死亡率。本研究共纳入 110 例中位年龄为 8 个月的患者：56 例被分配至自主呼吸试验组，54 例被分配至对照组。两组患者的人口统计学和临床数据以及先天性心脏病外科风险调整-1 分类相似。与对照组相比，行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 比 367 小时，p < 0.0001）。两组患者的总住院时间、呼吸机相关性肺炎发生率和死亡率无显著差异。
与根据临床判断撤机的患者相比，行自主呼吸试验的先天性心脏病术后儿科患者拔管成功率更高，PICU 住院时间更短。
