Spontaneous Breathing Trial for Prediction of Extubation Success in Pediatric Patients Following Congenital Heart Surgery: A Randomized Controlled Trial*

Abstract

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 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. 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.

Modified ABCDEF-Bundles for Critically Ill Pediatric Patients - What Could They Look Like?

“…However, for patients with congenital heart disease, spontaneous breathing trials and daily extubation readiness tests proved effective in reducing extubation failure and length of PICU-stay ( 53 , 54 ).…”

Co-ordinated multidisciplinary intervention to reduce time to successful extubation for children on mechanical ventilation: the SANDWICH cluster stepped-wedge RCT

“…Together, these factors may have mitigated the beneficial effect shown in smaller paediatric explanatory trials evaluating a SBT as a weaning intervention. 22,71,72 Given the small number of paediatric trials that have evaluated SBT as a weaning strategy, it is no surprise that there are discordant results reporting duration of IMV across studies. In a two-centre RCT recruiting mainly medical patients, Foronda et al 22 reported a reduction in the duration of IMV of > 24 hours in the SBT group (n = 294, median 3.5 vs. 4.7 days; p = 0.01).…”

Predictores de extubación fallida en el paciente pediátrico y neonatal

“…Se recomiendan las pruebas de respiración espontánea para ayudar a seleccionar al grupo de pacientes que se benefician de una extubación. Los pacientes sometidos a pruebas de respiración espontánea tienen mayor éxito en la extubación comparados con aquellos a los que no se les realiza (83% frente al 68%, p = 0,02) y tienen estancias más cortas en la unidad de cuidado intensivo pediátrico (mediana 85, frente a 367 horas, p <0,0001) (34). La finalización satisfactoria de una prueba de respiración podría predecir una extubación satisfactoria con una sensibilidad del 95%, con un valor predictivo positivo del 92% y una razón de posibilidades de 12 (IC 95%, 1,3 -53,7).…”