Identification and Prevention of Extubation Failure in Adults using an Automated Continuous Monitoring Alert vs Standard Care: A Randomized Controlled Trial

Abstract

Background: Post extubation monitoring helps identify patients at risk of developing respiratory failure. This study aimed to evaluate the effect of our standard respiratory therapist (RT) assessment tool versus an automated continuous monitoring alert to initiate RT driven care on the reintubation rate.

Methods: This was a single-center randomized clinical trial of adult subjects who received mechanical ventilation for more than 24 hours and underwent planned extubation in the intensive care unit (ICU) from March 2020 to September 2021. Subjects were assigned to standard RT assessment tool or an automated monitoring alert to identify the need for RT driven care. Primary outcome was need for reintubation due to respiratory failure within 72 hours. Secondary outcomes included reintubation within 7 days, ICU and hospital length of stay (LOS), hospital mortality, ICU cost and RT time associated with patient assessment and therapy provision.

Results: Of 234 randomized subjects, 32 were excluded from the primary analysis due to disruption in RT driven care during the COVID-19 patient surge and 1 due to delay in Integrated Pulmonary Index (IPI) monitoring initiation. Analysis of the primary outcome included 85 subjects assigned to the standard RT assessment group and 116 assigned to the automated monitoring alert group to initiate RT driven care. There was no significant difference between the study groups in reintubation rate, median LOS, mortality, or ICU costs. RT time associated with patient assessment (p<0.001) and therapy provided (p=0.031) were significantly lower in the automated continuous monitoring alert group.

Conclusions: In patients receiving mechanical ventilation for more than 24 hours, there were no significant outcome or cost differences between our standard RT assessment tool or an automated monitoring alert to initiate RT driven care. Using an automated continuous monitoring alert to initiate RT driven care saved RT time.

Trial Registration: clinicaltrials.gov Identifier: NCT04231890