title: The impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: a randomized controlled trial.
abstract: OBJECTIVE
  To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation.
  
  
  METHODS
  A prospective, randomized controlled trial.
  
  
  METHODS
  Two pediatric intensive care units at university hospitals in Brazil.
  
  
  METHODS
  The trial involved children between 28 days and 15 yrs of age who were receiving mechanical ventilation for at least 24 hrs.
  
  
  METHODS
  Patients were randomly assigned to one of two weaning protocols. In the test group, the children underwent a daily evaluation to check readiness for weaning with a spontaneous breathing test with 10 cm H2O pressure support and a positive end-expiratory pressure of 5 cm H2O for 2 hrs. The spontaneous breathing test was repeated the next day for children who failed it. In the control group, weaning was performed according to standard care procedures.
  
  
  RESULTS
  A total of 294 eligible children were randomized, with 155 to the test group and 139 to the control group. The time to extubation was shorter in the test group, where the median mechanical ventilation duration was 3.5 days (95% confidence interval, 3.0 to 4.0) as compared to 4.7 days (95% confidence interval, 4.1 to 5.3) in the control group (p = .0127). This significant reduction in the mechanical ventilation duration for the intervention group was not associated with increased rates of extubation failure or noninvasive ventilation. It represents a 30% reduction in the risk of remaining on mechanical ventilation (hazard ratio: 0.70).
  
  
  CONCLUSIONS
  A daily evaluation to check readiness for weaning combined with a spontaneous breathing test reduced the mechanical ventilation duration for children on mechanical ventilation for >24 hrs, without increasing the extubation failure rate or the need for noninvasive ventilation.
authors.affiliation: Intensive Care Unit, Hospital Sírio Libanês, São Paulo, Brazil. flikrepel@foronda.com.br
authors.forename: Flávia K
authors.initials: FK
authors.lastname: Foronda
authors.forename: Eduardo J
authors.initials: EJ
authors.lastname: Troster
authors.forename: Julio A
authors.initials: JA
authors.lastname: Farias
authors.forename: Carmen S
authors.initials: CS
authors.lastname: Barbas
authors.forename: Alexandre A
authors.initials: AA
authors.lastname: Ferraro
authors.forename: Lucília S
authors.initials: LS
authors.lastname: Faria
authors.forename: Albert
authors.initials: A
authors.lastname: Bousso
authors.forename: Flávia F
authors.initials: FF
authors.lastname: Panico
authors.forename: Artur F
authors.initials: AF
authors.lastname: Delgado
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D012129:Respiratory Function Tests; D015300:Ventilator Weaning / Q000379:methods*