Early vs. Delayed Switching from Controlled to Assisted Ventilation: A Target Trial Emulation.

IF 19.3 1区医学 Q1 CRITICAL CARE MEDICINE American journal of respiratory and critical care medicine Pub Date : 2025-01-21 DOI:10.1164/rccm.202406-1162oc

Carmen A T Reep,Evert-Jan Wils,Lucas M Fleuren,Alexander Breskin,Giacomo Bellani,John G Laffey,Laurent J Brochard,Tài Pham,Leo Heunks,

{"title":"Early vs. Delayed Switching from Controlled to Assisted Ventilation: A Target Trial Emulation.","authors":"Carmen A T Reep,Evert-Jan Wils,Lucas M Fleuren,Alexander Breskin,Giacomo Bellani,John G Laffey,Laurent J Brochard,Tài Pham,Leo Heunks,","doi":"10.1164/rccm.202406-1162oc","DOIUrl":null,"url":null,"abstract":"RATIONALE\r\nIn critically ill patients receiving invasive mechanical ventilation, switching from controlled to assisted ventilation is a crucial milestone towards ventilator liberation. The optimal timing for switching to assisted ventilation has not been studied.\r\n\r\nOBJECTIVES\r\nOur objective was to determine whether a strategy of early as compared to delayed switching affects the duration of invasive mechanical ventilation, ICU length of stay, and mortality.\r\n\r\nMETHODS\r\nWe conducted a target trial emulation using the prospective, global WEAN SAFE dataset. Patients were eligible for switching if still on controlled mechanical ventilation, not receiving neuromuscular blockers, and PaO2/FiO2 ratio >150 mmHg. We compared an \"early switching\" strategy (switch within one day after reaching switching eligibility criteria) to a \"delayed switching\" strategy (switch one or more days after reaching the switching eligibility criteria). Primary outcome was the 28-day cumulative incidence of successful extubation. Secondary outcomes included 28-day and 90-day ICU discharge and ICU mortality.\r\n\r\nMEASUREMENTS AND MAIN RESULTS\r\n1489 patients met the switching eligibility criteria. The early switch group had, on average, 4 additional days of being successfully extubated over the 28-day period (95% CI: 3, 6; P<0.001) compared to the delayed group, with a higher difference in cumulative incidence of successful extubation at day 28 (7%; 95% CI: 0, 13; P=0.04). Early switching was associated with an 11% higher cumulative incidence of ICU discharge at day 28 (95% CI: 7, 18; P<0.001) and an average of 7 additional days discharged from the ICU over the 90-day period (95% CI: 4, 12; P<0.001) compared to delayed switching. ICU mortality rates did not differ between the strategies.\r\n\r\nCONCLUSIONS\r\nEarly switching from controlled to assisted ventilation is associated with shorter duration of invasive mechanical ventilation and ICU stay compared to delayed switching.","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"98 1","pages":""},"PeriodicalIF":19.3000,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of respiratory and critical care medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1164/rccm.202406-1162oc","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

RATIONALE In critically ill patients receiving invasive mechanical ventilation, switching from controlled to assisted ventilation is a crucial milestone towards ventilator liberation. The optimal timing for switching to assisted ventilation has not been studied. OBJECTIVES Our objective was to determine whether a strategy of early as compared to delayed switching affects the duration of invasive mechanical ventilation, ICU length of stay, and mortality. METHODS We conducted a target trial emulation using the prospective, global WEAN SAFE dataset. Patients were eligible for switching if still on controlled mechanical ventilation, not receiving neuromuscular blockers, and PaO2/FiO2 ratio >150 mmHg. We compared an "early switching" strategy (switch within one day after reaching switching eligibility criteria) to a "delayed switching" strategy (switch one or more days after reaching the switching eligibility criteria). Primary outcome was the 28-day cumulative incidence of successful extubation. Secondary outcomes included 28-day and 90-day ICU discharge and ICU mortality. MEASUREMENTS AND MAIN RESULTS 1489 patients met the switching eligibility criteria. The early switch group had, on average, 4 additional days of being successfully extubated over the 28-day period (95% CI: 3, 6; P<0.001) compared to the delayed group, with a higher difference in cumulative incidence of successful extubation at day 28 (7%; 95% CI: 0, 13; P=0.04). Early switching was associated with an 11% higher cumulative incidence of ICU discharge at day 28 (95% CI: 7, 18; P<0.001) and an average of 7 additional days discharged from the ICU over the 90-day period (95% CI: 4, 12; P<0.001) compared to delayed switching. ICU mortality rates did not differ between the strategies. CONCLUSIONS Early switching from controlled to assisted ventilation is associated with shorter duration of invasive mechanical ventilation and ICU stay compared to delayed switching.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

求助全文

约1分钟内获得全文去求助

来源期刊

American journal of respiratory and critical care medicine 医学-呼吸系统

CiteScore

27.30

自引率

4.50%

发文量

1313

审稿时长

3-6 weeks

期刊介绍： The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.

期刊最新文献

Insights into Pulmonary Heart Disease at High Altitude: Hypoxia and PM2.5 Interactions. Stop the Asthma Treatment Elevator, We Need to Get Off! Novel Therapies for Sleep Disorder Breathing. Location of Care Delivery for Pulmonary Arterial Hypertension in the United States. Early vs. Delayed Switching from Controlled to Assisted Ventilation: A Target Trial Emulation.