Mitting Rebecca B, McDowell Cliona, Blackwood Bronagh, Ray Samiran
Paediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, United Kingdom.
Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, United Kingdom.
Pediatr Crit Care Med. 2025 Apr 1;26(4):e423-e431. doi: 10.1097/PCC.0000000000003685. Epub 2025 Jan 23.
The Sedation and Weaning in Children (SANDWICH) trial of a sedation weaning and ventilator liberation bundle had a primary outcome of time to successful extubation, and showed significant but small difference. We explored the impact of the intervention on infants with bronchiolitis.
Post hoc subgroup analysis of a cluster-randomized trial, 2018 to 2019 (ISRCTN16998143).
Surviving patients with bronchiolitis under 1 year of age in the SANDWICH trial ( n = 784).
Nil.
Time to successful extubation, and rates of unplanned and failed extubation were compared in patients exposed and not exposed to the intervention. To explore a site-level effect, we tested the correlation between the rate of unplanned and failed extubation at each trial site with the median time to successful extubation at that site. Of 784 patients (48%), 376 were exposed to the intervention. Median (interquartile range [IQR]) time to successful extubation was 69.6 (IQR 50.4-110.4) hours in patients exposed to the intervention and 86.4 (IQR 60-124.8) hours in non-exposed. Exposure to the SANDWICH intervention was associated with a 13% (95% CI, 1%-26%) reduction in time to extubation following adjustment for confounders. Thirty (3.8%) patients experienced unplanned extubation and 112 (14%) failed extubation. Patients who experienced failed extubation had an increased time to successful extubation, which remained significant after adjustment for confounders. At the site level, there was a negative correlation between failed extubation rate and median time to successful extubation (Spearman rho -0.53 [95% CI, -0.8 to -0.08], p = 0.02).
In a secondary analysis of the SANDWICH trial, the subgroup of bronchiolitis patients showed that exposure to the intervention was associated with a clinically significant reduction in time to successful extubation. Although failed extubation was associated with increased duration of ventilation in an individual, sites with higher rates of failed extubation had a lower median duration of ventilation.
儿童镇静与撤机（SANDWICH）试验采用了一种镇静撤机和呼吸机解放综合方案，其主要结局为成功拔管时间，结果显示差异显著但较小。我们探讨了该干预措施对患细支气管炎婴儿的影响。
2018年至2019年一项整群随机试验的事后亚组分析（ISRCTN16998143）。
SANDWICH试验中1岁以下患细支气管炎的存活患者（n = 784）。
无。
比较了接受和未接受干预的患者的成功拔管时间、意外拔管率和拔管失败率。为探究机构层面的影响，我们检验了每个试验机构的意外拔管率和拔管失败率与该机构成功拔管中位时间之间的相关性。在784例患者（48%）中，376例接受了干预。接受干预的患者成功拔管的中位（四分位间距[IQR]）时间为69.6（IQR 50.4 - 110.4）小时，未接受干预的患者为86.4（IQR 60 - 124.8）小时。在对混杂因素进行调整后，接受SANDWICH干预与拔管时间缩短13%（95%CI，1% - 26%）相关。30例（3.8%）患者发生意外拔管，112例（14%）拔管失败。拔管失败的患者成功拔管时间延长，在对混杂因素进行调整后仍具有显著性。在机构层面，拔管失败率与成功拔管中位时间呈负相关（Spearman相关系数 -0.53 [95%CI， -0.8至 -0.08]，p = 0.02）。
在SANDWICH试验的二次分析中，细支气管炎患者亚组显示接受干预与成功拔管时间在临床上显著缩短相关。虽然个体拔管失败与通气时间延长相关，但拔管失败率较高的机构通气中位时间较短。
