FAST (T-piece SBT, frequent screening vs. daily screening)
Trial question
What is the role of frequent screening and T-piece spontaneous breathing trial in critically ill patients who received invasive mechanical ventilation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
40.0% female
60.0% male
N = 404
404 patients (162 female, 242 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=200 frequent screening (at least BID screening and T-piece spontaneous breathing trial lasting 30-120 minutes).
N=204 daily screening (once-daily screening and T-piece spontaneous breathing trial lasting 30-120 minutes).
Primary outcome
Median time to successful extubation
2.9 days
3.1 days
3.1 days
2.3 days
1.6 days
0.8 days
0.0 days
Frequent
screening
Daily
screening
No significant
difference ↔
No significant difference in median time to successful extubation (2.9 days vs. 3.1 days; HR 0.91, 95% CI 0.71 to 1.25).
Secondary outcomes
No significant difference in median time to first successful spontaneous breathing trial (1 days vs. 1.1 days; HR 0.91, 95% CI 0.67 to 1.11).
Significant decrease in median duration of ventilation in the ICU (55.6 hours vs. 71.7 hours; IRR 0.9, 95% CI 0.9 to 0.9).
No significant difference in death at day 90 (18% vs. 19.1%; OR 0.9, 95% CI 0.5 to 1.8).
Safety outcomes
No significant difference in adverse events.
Conclusion
In critically ill patients who received invasive mechanical ventilation for > 24 hours, frequent screening was not superior to daily screening 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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