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Background <p>To investigate the effect of different durations of pressure support ventilation (PSV) after a spontaneous breathing trial (SBT) on 48-hour reintubation rates in critically ill subjects.</p> Methods <p>This single-center retrospective cohort study included adult subjects who received mechanical ventilation for over 48&#xa0;h, successfully completed SBT, and were scheduled for extubation in the intensive care unit of a tertiary hospital between January and December 2023. Subjects were divided into three groups based on PSV duration after SBT: direct extubation (DE, ≤ 30&#xa0;min), short-term PSV (SP, 30&#xa0;min–3&#xa0;h), and long-term PSV (LP, 3–12&#xa0;h). The primary outcome was the 48-hour reintubation rate. The secondary outcomes included intensive care unit length of stay and 28-day mortality.</p> Results <p>A total of 982 subjects were included (638, 235, and 109 in the DE, SP, and LP groups, respectively). The 48-hour reintubation rates were 18.34%, 14.04%, and 16.51% in the DE, SP, and LP groups, respectively (<i>P</i> = 0.298). Multivariate logistic regression showed no significant difference in reintubation risk for SP (OR = 0.73, <i>P</i> = 0.141) and LP groups (OR = 0.88, <i>P</i> = 0.643) compared with the DE group. Age (OR = 1.18, <i>P</i> = 0.003) and APACHE II score (OR = 1.07, <i>P</i> &lt; 0.001) were identified as independent risk factors for reintubation. The median intensive care unit length of stay was 16 days in the DE group, 18 days in the SP group, and 19 days in the LP group (<i>P</i> = 0.033). The 28-day mortality did not differ significantly among groups (12.85%, 11.91%, and 14.68%, respectively; <i>P</i> = 0.690).</p> Conclusions <p>PSV duration after SBT did not significantly affect reintubation rates in the overall population. While short-term PSV showed potential benefits in specific subgroups, particularly COPD patients, direct extubation after successful SBT appears safe for most patients and may reduce ICU length of stay. These findings suggest that extubation strategies should be individualized based on patient characteristics rather than applying extended PSV periods universally.</p>

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Impact of pressure support ventilation duration after a spontaneous breathing trial on reintubation rates in critically ill subjects: a retrospective study

  • 期刊论文

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  • 发表日期：

    2025年6月7日

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  • Jinlong Xu,
  • Zefang Liu,
  • Simei Wang,
  • Zhenghua Liang,
  • Qiuyu Liu,
  • Zhihua Xu,
  • Pingzhen Wu,
  • Lijun Liang

摘要

Background

To investigate the effect of different durations of pressure support ventilation (PSV) after a spontaneous breathing trial (SBT) on 48-hour reintubation rates in critically ill subjects.

Methods

This single-center retrospective cohort study included adult subjects who received mechanical ventilation for over 48 h, successfully completed SBT, and were scheduled for extubation in the intensive care unit of a tertiary hospital between January and December 2023. Subjects were divided into three groups based on PSV duration after SBT: direct extubation (DE, ≤ 30 min), short-term PSV (SP, 30 min–3 h), and long-term PSV (LP, 3–12 h). The primary outcome was the 48-hour reintubation rate. The secondary outcomes included intensive care unit length of stay and 28-day mortality.

Results

A total of 982 subjects were included (638, 235, and 109 in the DE, SP, and LP groups, respectively). The 48-hour reintubation rates were 18.34%, 14.04%, and 16.51% in the DE, SP, and LP groups, respectively (P = 0.298). Multivariate logistic regression showed no significant difference in reintubation risk for SP (OR = 0.73, P = 0.141) and LP groups (OR = 0.88, P = 0.643) compared with the DE group. Age (OR = 1.18, P = 0.003) and APACHE II score (OR = 1.07, P < 0.001) were identified as independent risk factors for reintubation. The median intensive care unit length of stay was 16 days in the DE group, 18 days in the SP group, and 19 days in the LP group (P = 0.033). The 28-day mortality did not differ significantly among groups (12.85%, 11.91%, and 14.68%, respectively; P = 0.690).

Conclusions

PSV duration after SBT did not significantly affect reintubation rates in the overall population. While short-term PSV showed potential benefits in specific subgroups, particularly COPD patients, direct extubation after successful SBT appears safe for most patients and may reduce ICU length of stay. These findings suggest that extubation strategies should be individualized based on patient characteristics rather than applying extended PSV periods universally.