Sedation and Ventilator Weaning Bundle and Time to Extubation in Infants With Bronchiolitis: Secondary Analysis of the Sedation AND Weaning in Children (SANDWICH) Trial.

IF 4.5 2区医学 Q1 CRITICAL CARE MEDICINE

Pediatric Critical Care Medicine Pub Date : 2025-04-01 Epub Date: 2025-01-23 DOI:10.1097/PCC.0000000000003685

Rebecca B Mitting, Cliona McDowell, Bronagh Blackwood, Samiran Ray

{"title":"Sedation and Ventilator Weaning Bundle and Time to Extubation in Infants With Bronchiolitis: Secondary Analysis of the Sedation AND Weaning in Children (SANDWICH) Trial.","authors":"Rebecca B Mitting, Cliona McDowell, Bronagh Blackwood, Samiran Ray","doi":"10.1097/PCC.0000000000003685","DOIUrl":null,"url":null,"abstract":"Objective: The Sedation and Weaning in Children (SANDWICH) trial of a sedation weaning and ventilator liberation bundle had a primary outcome of time to successful extubation, and showed significant but small difference. We explored the impact of the intervention on infants with bronchiolitis.Design: Post hoc subgroup analysis of a cluster-randomized trial, 2018 to 2019 (ISRCTN16998143).Patients: Surviving patients with bronchiolitis under 1 year of age in the SANDWICH trial ( n = 784).Interventions: Nil.Measurements and main results: Time to successful extubation, and rates of unplanned and failed extubation were compared in patients exposed and not exposed to the intervention. To explore a site-level effect, we tested the correlation between the rate of unplanned and failed extubation at each trial site with the median time to successful extubation at that site. Of 784 patients (48%), 376 were exposed to the intervention. Median (interquartile range [IQR]) time to successful extubation was 69.6 (IQR 50.4-110.4) hours in patients exposed to the intervention and 86.4 (IQR 60-124.8) hours in non-exposed. Exposure to the SANDWICH intervention was associated with a 13% (95% CI, 1%-26%) reduction in time to extubation following adjustment for confounders. Thirty (3.8%) patients experienced unplanned extubation and 112 (14%) failed extubation. Patients who experienced failed extubation had an increased time to successful extubation, which remained significant after adjustment for confounders. At the site level, there was a negative correlation between failed extubation rate and median time to successful extubation (Spearman rho -0.53 [95% CI, -0.8 to -0.08], p = 0.02).Conclusions: In a secondary analysis of the SANDWICH trial, the subgroup of bronchiolitis patients showed that exposure to the intervention was associated with a clinically significant reduction in time to successful extubation. Although failed extubation was associated with increased duration of ventilation in an individual, sites with higher rates of failed extubation had a lower median duration of ventilation.","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e423-e431"},"PeriodicalIF":4.5000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960679/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000003685","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: The Sedation and Weaning in Children (SANDWICH) trial of a sedation weaning and ventilator liberation bundle had a primary outcome of time to successful extubation, and showed significant but small difference. We explored the impact of the intervention on infants with bronchiolitis.

Design: Post hoc subgroup analysis of a cluster-randomized trial, 2018 to 2019 (ISRCTN16998143).

Patients: Surviving patients with bronchiolitis under 1 year of age in the SANDWICH trial ( n = 784).

Interventions: Nil.

Measurements and main results: Time to successful extubation, and rates of unplanned and failed extubation were compared in patients exposed and not exposed to the intervention. To explore a site-level effect, we tested the correlation between the rate of unplanned and failed extubation at each trial site with the median time to successful extubation at that site. Of 784 patients (48%), 376 were exposed to the intervention. Median (interquartile range [IQR]) time to successful extubation was 69.6 (IQR 50.4-110.4) hours in patients exposed to the intervention and 86.4 (IQR 60-124.8) hours in non-exposed. Exposure to the SANDWICH intervention was associated with a 13% (95% CI, 1%-26%) reduction in time to extubation following adjustment for confounders. Thirty (3.8%) patients experienced unplanned extubation and 112 (14%) failed extubation. Patients who experienced failed extubation had an increased time to successful extubation, which remained significant after adjustment for confounders. At the site level, there was a negative correlation between failed extubation rate and median time to successful extubation (Spearman rho -0.53 [95% CI, -0.8 to -0.08], p = 0.02).

Conclusions: In a secondary analysis of the SANDWICH trial, the subgroup of bronchiolitis patients showed that exposure to the intervention was associated with a clinically significant reduction in time to successful extubation. Although failed extubation was associated with increased duration of ventilation in an individual, sites with higher rates of failed extubation had a lower median duration of ventilation.

查看原文本刊更多论文

毛细支气管炎婴儿镇静和呼吸机脱机时间和拔管时间：儿童镇静和脱机的二次分析（SANDWICH）试验。

目的：儿童镇静与脱机（SANDWICH）试验中，镇静脱机与呼吸机解放束的主要结局指标为成功拔管时间，差异有统计学意义但不显著。我们探讨了干预对毛细支气管炎婴儿的影响。设计：2018 - 2019年集群随机试验的事后亚组分析（ISRCTN16998143）。患者：在SANDWICH试验中存活的1岁以下毛细支气管炎患者（n = 784）。干预措施:零。测量结果和主要结果：比较接受和未接受干预的患者成功拔管的时间、计划外拔管和失败拔管的比率。为了探讨部位水平效应，我们测试了每个试验部位计划外拔管失败率与该部位成功拔管的中位数时间之间的相关性。在784名患者（48%）中，376名患者接受了干预。暴露于干预措施的患者成功拔管的中位时间（四分位间距[IQR]）为69.6 （IQR 50.4-110.4）小时，未暴露于干预措施的患者为86.4 （IQR 60-124.8）小时。在调整混杂因素后，接受SANDWICH干预与拔管时间减少13% （95% CI, 1%-26%）相关。30例（3.8%）患者出现计划外拔管，112例（14%）拔管失败。拔管失败的患者拔管成功的时间增加，在调整混杂因素后仍然显着。在部位水平，拔管失败率与拔管成功的中位时间呈负相关（Spearman ρ -0.53 [95% CI, -0.8 ~ -0.08], p = 0.02）。结论：在SANDWICH试验的二次分析中，细支气管炎患者亚组显示，接受干预与成功拔管时间的临床显著减少有关。虽然拔管失败与个体通气持续时间的增加有关，但拔管失败率较高的部位通气持续时间的中位数较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Pediatric Critical Care Medicine 医学-危重病医学

CiteScore

7.40

自引率

14.60%

发文量

991

审稿时长

3-8 weeks

期刊介绍： Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.