2012 OPEN FORUM Abstracts
DURATION OF THE SPONTANEOUS BREATHING TRIAL IS A PREDICTOR OF REINTUBATION.
Ruben D. Restrepo1, Arthur Taft2, David Vines3, Kevin Walsh4, Susan Whiddon2, Ramona Herrington2, Manuel Castresana2; 1Respiratory Care, UTHSCSA, San Antonio, TX; 2Respiratory Care, Georgia Health Sciences University, Augusta, GA; 3Respiratory Care, Rush University, Chicago, IL; 4Respiratory Therapy, Univeristy Hospital, San Antonio, TX
Background: Nearly 40% of the time spent on mechanical ventilation is devoted to the weaning process. When extubation happens on the same day of the first spontaneous breathing trial (SBT) is called a simple weaning. Prolonged weaning has been associated with increased mortality in the intensive care unit (ICU). While SBTs are typically performed between 30 min and 2 h to determine readiness for extubation, we wanted to evaluate if the time spent on the SBT was a predictor of successful extubation in a group of patients admitted to three different medical-surgical ICUs in the US. Methods: In this observational study, we enrolled patients who were considered ready to undergo a SBT by the physician in charge in medical and surgical ICUs of three participating centers in the US. Information recorded for up to three SBTs per patient included demographics, duration of the SBT, if passed or failed SBT, extubation, and reintubation rates. The patients were followed until 48h post extubation or until discharge from the ICU. SBTs were classified according to duration in 3 categories: 1. SBT < 30min; 2. SBT 30min-2h; 3. SBT >2h. The IRB of each participating institution approved the study protocol with a waiver of informed consent. Descriptive statistics and correlations were performed using SPSS 17.0. Results: A total of 151 patients with orders to be placed on SBT were selected for analysis. Although the 3 centers reported different overall mean duration of SBTs (29 min, 69 min, 76 min), the majority of patients remained on SBT between 30 min and 2 h despite the number of breathing trials required prior to extubation (SBT1: 38 min; SBT2: 38 min; SBT3: 51 min). Forty nine (32%) patients required SBT2, and 24 (16%) required SBT3. Patients were deemed to be ready for extubation in 157 out of 231 SBTs performed during the study. However, only 80% of those events resulted in an order to extubate. Information on 131 subjects 48 hours post extubation revealed an overall reintubation rate of 9.2%. There was a significant but weak correlation between the overall duration of the SBT (58 min, r=.212, p=0.026), the duration of the last passed SBT (79 min, r=.211, p=0.027) and reintubation rates. Conclusion: Our study suggests that placing patients on SBT for more than 30 min may be a risk factor for reintubation. Sponsored Research - Oridion Capnography