F Frutos-Vivar1, O Peñuelas2, A Muriel3, J Mancebo4, A García-Jiménez5, R de Pablo6, M Valledor7, M Ferrer8, M León9, J M Quiroga10, S Temprano11, I Vallverdú12, R Fernández13, F Gordo14, A Anzueto15, A Esteban2. 1. Hospital Universitario de Getafe, Madrid, España. Electronic address: fernando.frutos@salud.madrid.org. 2. Hospital Universitario de Getafe, Madrid, España. 3. Unidad de Bioestadística Clínica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España. 4. Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, España. 5. Hospital Arquitecto Marcide, Ferrol, España. 6. Hospital Ramón y Cajal, Madrid, España. 7. Hospital de San Agustín, Avilés, España. 8. Hospital Clinic-IDIBAPS, Barcelona, España. 9. Hospital Arnau de Vilanova, Lleida, España. 10. Hospital de Cabueñes, Gijón, España. 11. Hospital 12 de Octubre, Madrid, España. 12. Hospital Universitari San Juan, Reus, España. 13. Hospital Sant Joan de Déu, Fundació Althaia, Manresa, España. 14. Grupo de Investigación en Patología Crítica. Universidad Francisco de Vitoria, Pozuelo de Alarcón. Hospital Universitario del Henares, Coslada, España. 15. South Texas Veterans Health Care System and University of Texas Health, San Antonio, Texas, Estados Unidos.
Abstract
PURPOSE: To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. DESIGN: Post-hoc analysis of four cohort studies. AMBIT: 138 Spanish ICUs. PATIENTS: 2141 patients scheduled extubated. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. RESULTS: There was a significant increase (p<0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p=0.435). CONCLUSIONS: There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.
PURPOSE: To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. DESIGN: Post-hoc analysis of four cohort studies. AMBIT: 138 Spanish ICUs. PATIENTS: 2141 patients scheduled extubated. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. RESULTS: There was a significant increase (p<0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p=0.435). CONCLUSIONS: There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.