FAST (frequent screening, SBT-PS vs. T-piece SBT)
Trial question
What is the role of frequent screening and pressure-supported spontaneous breathing trial in critically ill patients who received invasive mechanical ventilation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
39.0% female
61.0% male
N = 395
395 patients (154 female, 241 male).
Inclusion criteria: critically ill patients who received invasive mechanical ventilation for > 24 hours.
Key exclusion criteria: hospitalization after cardiopulmonary arrest or with brain death or expected brain death; evidence of myocardial ischemia in the 24 hour period before enrolment; continuous invasive mechanical ventilation for ≥ 2 weeks; tracheostomy in situ; sedative infusions for seizures or alcohol withdrawal; requirement of escalating doses of sedative agents.
Interventions
N=195 pressure-supported SBT (at least BID screening and pressure-supported spontaneous breathing trial lasting 30-120 minutes).
N=200 T-piece SBT (at least BID screening and T-piece spontaneous breathing trial lasting 30-120 minutes).
Primary outcome
Median time to successful extubation
3.9 days
2.9 days
3.9 days
2.9 days
1.9 days
1.0 days
0.0 days
Pressure-supported
SBT
T-piece
SBT
No significant
difference ↔
No significant difference in median time to successful extubation (3.9 days vs. 2.9 days; HR 1.11, 95% CI 0.91 to 1.43).
Secondary outcomes
No significant difference in median time to first successful spontaneous breathing trial (0.9 days vs. 1 days; HR 1, 95% CI 0.71 to 1.25).
Significant increase in median duration of ventilation in the ICU (82.2 hours vs. 55.6 hours; IRR 1.3, 95% CI 1.3 to 1.3).
No significant difference in death at day 90 (22.1% vs. 18%; OR 1.3, 95% CI 0.7 to 2.5).
Safety outcomes
No significant difference in adverse events.
Conclusion
In critically ill patients who received invasive mechanical ventilation for > 24 hours, pressure-supported SBT was not superior to T-piece SBT with respect to median time to successful extubation.
Reference
Karen E A Burns, Jessica Wong, Leena Rizvi et al. Frequency of Screening and Spontaneous Breathing Trial Techniques: A Randomized Clinical Trial. JAMA. 2024 Dec 3;332(21):1808-1821.
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