ObjectiveTo investigate whether protocol-directed weaning in neurocritical patients
would reduce the rate of extubation failure (as a primary outcome) and the
associated complications (as a secondary outcome) compared with conventional
weaning.MethodsA quasi-experimental study was conducted in a medical-surgical intensive care
unit from January 2016 to December 2018. Patients aged 18 years or older
with an acute neurological disease who were on mechanical ventilation >
24 hours were included. All patients included in the study were ready to
wean, with no or minimal sedation, Glasgow coma score ≥ 9,
spontaneous ventilatory stimulus, noradrenaline ≤ 0.2µgr/kg/
minute, fraction of inspired oxygen ≤ 0.5, positive end-expiratory
pressure ≤ 5cmH2O, maximal inspiratory pressure <
-20cmH2O, and occlusion pressure < 6cmH2O.ResultsNinety-four of 314 patients admitted to the intensive care unit were included
(50 in the Intervention Group and 44 in the Control Group). There was no
significant difference in spontaneous breathing trial failure (18% in the
Intervention Groupversus34% in the Control Group, p =
0.12). More patients in the Intervention Group were extubated than in the
Control Group (100%versus79%, p = 0.01). The rate of
extubation failure was not signifiantly diffrent between the groups (18% in
the Intervention Groupversus17% in the Control Group;
relative risk 1.02; 95%CI 0.64 - 1.61; p = 1.00). The reintubation rate was
lower in the Control Group (16% in the Intervention Groupversus11% in the Control Group; relative risk 1.15;
95%CI 0.74 - 1.82; p = 0.75). The need for tracheotomy was lower in the
Intervention Group [4 (8%)versus11 (25%) in the
Control Group; relative risk 0.32; 95%CI 0.11 - 0.93; p = 0.04]. At
Day 28, the patients in the Intervention Group had more ventilator-free days
than those in the Control Group [28 (26 - 28) daysversus26 (19 - 28) days; p = 0.01]. The total
duration of mechanical ventilation was shorter in the Intervention Group
than in the Control Group [5 (2 - 13) daysversus9
(3 - 22) days; p = 0.01]. There were no diffrences in the length of
intensive care unit stay, 28-day free from mechanical ventilation, hospital
stay or 90-day mortality.ConclusionConsidering the limitations of our study, the application of a weaning
protocol for neurocritical patients led to a high percentage of extubation,
a reduced need for tracheotomy and a shortened duration of mechanical
ventilation. However, there was no reduction in extubation failure or the
28-day free of from mechanical ventilation compared with the Control
Group.ClinicalTrials.gov Registry:NCT03128086