Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning
Breathe trial design and results
Design
Randomised clinical trial
Treatment
Protocolised early extubation onto non-invasive ventilation
Control
Continued invasive weaning
Population
364 patients with respiratory failure who failed a spontaneous breathing trial, mean age 63.1, 50.5% male
Follow-up
180 days
Primary endpoint
Time to liberation from mechanical ventilation
Result
Median time to liberation 4.3 days with non-invasive weaning versus 4.5 days with invasive weaning — adjusted hazard ratio 1.1 (95% CI 0.89 to 1.40). The non-invasive group received less invasive ventilation (median 1 versus 4 days, incidence rate ratio 0.6, 95% CI 0.47 to 0.87) and fewer total ventilator days (3 versus 4). No significant difference in reintubation or tracheostomy rates.
Secondary endpoints
Invasive ventilation days, total ventilator days, reintubation, tracheostomy, mortality
Among patients requiring mechanical ventilation in whom a spontaneous breathing trial had failed, early extubation to noninvasive ventilation did not shorten time to liberation from any ventilation.
The trial authors, in the published abstract
How it has aged
Trades three days of invasive ventilation for the same total weaning time. Whether that is worth doing depends on how much you weigh tube-related complications against mask burden — the trial gives you the numbers rather than the answer.
Publications
Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure: The Breathe Randomized Clinical Trial
Perkins GD, Mistry D, Gates S, et al. Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure: The Breathe Randomized Clinical Trial. JAMA 2018 Nov 13;320(18):1881-1888.
No difference in time to liberation from ventilation