Document Detail


Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation: a randomized trial.
MedLine Citation:
PMID:  23340588     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
IMPORTANCE: Patients requiring prolonged mechanical ventilation (>21 days) are commonly weaned at long-term acute care hospitals (LTACHs). The most effective method of weaning such patients has not been investigated.
OBJECTIVE: To compare weaning duration with pressure support vs unassisted breathing through a tracheostomy collar in patients transferred to an LTACH for weaning from prolonged ventilation.
DESIGN, SETTING, AND PARTICIPANTS: Between 2000 and 2010, a randomized study was conducted in tracheotomized patients transferred to a single LTACH for weaning from prolonged ventilation. Of 500 patients who underwent a 5-day screening procedure, 316 did not tolerate the procedure and were randomly assigned to receive weaning with pressure support (n = 155) or a tracheostomy collar (n = 161). Survival at 6- and 12-month time points was also determined.
MAIN OUTCOME MEASURE: Primary outcome was weaning duration. Secondary outcome was survival at 6 and 12 months after enrollment.
RESULTS: Of 316 patients, 4 were withdrawn and not included in analysis. Of 152 patients in the pressure-support group, 68 (44.7%) were weaned; 22 (14.5%) died. Of 160 patients in the tracheostomy collar group, 85 (53.1%) were weaned; 16 (10.0%) died. Median weaning time was shorter with tracheostomy collar use (15 days; interquartile range [IQR], 8-25) than with pressure support (19 days; IQR, 12-31), P = .004. The hazard ratio (HR) for successful weaning rate was higher with tracheostomy collar use than with pressure support (HR, 1.43; 95% CI, 1.03-1.98; P = .033) after adjusting for baseline clinical covariates. Use of the tracheostomy collar achieved faster weaning than did pressure support among patients who did not tolerate the screening procedure between 12 and 120 hours (HR, 3.33; 95% CI, 1.44-7.70; P = .005), whereas weaning time was equivalent with the 2 methods in patients who did not tolerate the screening procedure within 0 to 12 hours. Mortality was equivalent in the pressure-support and tracheostomy collar groups at 6 months (55.92% vs 51.25%; 4.67% difference, 95% CI, -6.4% to 15.7%) and at 12 months (66.45% vs 60.00%; 6.45% difference, 95% CI, -4.2% to 17.1%).
CONCLUSION AND RELEVANCE: Among patients requiring prolonged mechanical ventilation and treated at a single long-term care facility, unassisted breathing through a tracheostomy, compared with pressure support, resulted in shorter median weaning time, although weaning mode had no effect on survival at 6 and 12 months.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01541462.
Authors:
Amal Jubran; Brydon J B Grant; Lisa A Duffner; Eileen G Collins; Dorothy M Lanuza; Leslie A Hoffman; Martin J Tobin
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JAMA     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-20     Completed Date:  2013-02-22     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  671-7     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT01541462
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MeSH Terms
Descriptor/Qualifier:
Aged
Female
Humans
Long-Term Care
Male
Middle Aged
Positive-Pressure Respiration / methods*
Respiration
Survival Analysis
Time Factors
Tracheostomy / instrumentation*
Treatment Outcome
Ventilator Weaning / methods*
Grant Support
ID/Acronym/Agency:
R01 NR008782/NR/NINR NIH HHS; R01 NR008782/NR/NINR NIH HHS
Comments/Corrections
Comment In:
JAMA. 2013 Feb 20;309(7):719-20   [PMID:  23423418 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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