Efficacy and safety of a paired sedation and ventilator weaning protocol
Wake up and breathe trial design and results
Design
Randomised controlled trial
Treatment
Daily spontaneous awakening trial paired with a daily spontaneous breathing trial
Control
Usual sedation practice with daily spontaneous breathing trials
Population
336 mechanically ventilated patients in intensive care
Follow-up
1 year
Primary endpoint
Ventilator-free days during a 28-day study period
Result
Patients in the intervention group spent more days breathing without assistance during the 28-day period, 14.7 days versus fewer in the control group. Benefits extended to earlier discharge and improved one-year survival.
Secondary endpoints
ICU and hospital length of stay, one-year mortality, self-extubation
Our results suggest that a wake up and breathe protocol that pairs daily spontaneous awakening trials (ie, interruption of sedatives) with daily spontaneous breathing trials results in better outcomes for mechanically ventilated patients in intensive care than current standard approaches and should become routine practice.
The trial authors, in the published abstract
How it has aged
The origin of the paired awakening-and-breathing protocol embedded in every modern ICU liberation bundle. It is also part of the wider re-evaluation of deep sedation that makes ROSE intelligible: less sedation, not more intervention.
Publications
Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial
Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 2008 Jan 12;371(9607):126-34.
More ventilator-free days than daily breathing trials alone
Improved one-year survival
More self-extubation, without an increase in reintubation overall