Xu Jinlong, Liu Zefang, Wang Simei, Liang Zhenghua, Liu Qiuyu, Xu Zhihua, Wu Pingzhen, Liang Lijun
Intensive Care Unit, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China.
BMC Pulm Med. 2025 Jun 7;25(1):285. doi: 10.1186/s12890-025-03744-4.
To investigate the effect of different durations of pressure support ventilation (PSV) after a spontaneous breathing trial (SBT) on 48-hour reintubation rates in critically ill subjects.
This single-center retrospective cohort study included adult subjects who received mechanical ventilation for over 48 h, successfully completed SBT, and were scheduled for extubation in the intensive care unit of a tertiary hospital between January and December 2023. Subjects were divided into three groups based on PSV duration after SBT: direct extubation (DE, ≤ 30 min), short-term PSV (SP, 30 min-3 h), and long-term PSV (LP, 3-12 h). The primary outcome was the 48-hour reintubation rate. The secondary outcomes included intensive care unit length of stay and 28-day mortality.
A total of 982 subjects were included (638, 235, and 109 in the DE, SP, and LP groups, respectively). The 48-hour reintubation rates were 18.34%, 14.04%, and 16.51% in the DE, SP, and LP groups, respectively (P = 0.298). Multivariate logistic regression showed no significant difference in reintubation risk for SP (OR = 0.73, P = 0.141) and LP groups (OR = 0.88, P = 0.643) compared with the DE group. Age (OR = 1.18, P = 0.003) and APACHE II score (OR = 1.07, P < 0.001) were identified as independent risk factors for reintubation. The median intensive care unit length of stay was 16 days in the DE group, 18 days in the SP group, and 19 days in the LP group (P = 0.033). The 28-day mortality did not differ significantly among groups (12.85%, 11.91%, and 14.68%, respectively; P = 0.690).
PSV duration after SBT did not significantly affect reintubation rates in the overall population. While short-term PSV showed potential benefits in specific subgroups, particularly COPD patients, direct extubation after successful SBT appears safe for most patients and may reduce ICU length of stay. These findings suggest that extubation strategies should be individualized based on patient characteristics rather than applying extended PSV periods universally.
探讨重症患者自主呼吸试验（SBT）后不同时长的压力支持通气（PSV）对48小时再插管率的影响。
这项单中心回顾性队列研究纳入了在2023年1月至12月期间于一家三级医院重症监护病房接受机械通气超过48小时、成功完成SBT且计划进行拔管的成年患者。根据SBT后PSV时长将患者分为三组：直接拔管（DE，≤30分钟）、短期PSV（SP，30分钟至3小时）和长期PSV（LP，3至12小时）。主要结局是48小时再插管率。次要结局包括重症监护病房住院时长和28天死亡率。
共纳入982例患者（DE组638例、SP组235例、LP组109例）。DE组、SP组和LP组的48小时再插管率分别为18.34%、14.04%和16.51%（P = 0.298）。多因素逻辑回归显示，与DE组相比，SP组（OR = 0.73，P = 0.141）和LP组（OR = 0.88，P = 0.643）的再插管风险无显著差异。年龄（OR = 1.18，P = 0.003）和急性生理与慢性健康状况评分系统II（APACHE II）评分（OR = 1.07，P < 0.001）被确定为再插管的独立危险因素。DE组重症监护病房住院时长中位数为16天，SP组为18天，LP组为19天（P = 0.033）。各组28天死亡率无显著差异（分别为12.85%、11.91%和14.68%；P = 0.690）。
SBT后PSV时长对总体人群的再插管率无显著影响。虽然短期PSV在特定亚组（尤其是慢性阻塞性肺疾病患者）中显示出潜在益处，但成功SBT后直接拔管对大多数患者似乎是安全的，且可能缩短重症监护病房住院时长。这些发现表明，拔管策略应根据患者特征个体化制定，而非普遍应用延长的PSV时长。
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