Arnaud W Thille, Constance Bayon, Marie Gauvrit, Clément Saccheri, Marie Labruyere, Gaetan Beduneau, Guilhem Wattecamps, Matthieu Henry, Eddine Bendiab, Benjamin Swinyard, Arnaud Gacouin, Adam Celier, Benjamin Foucou, Suzanne Champion, Anne-Fleur Haudebourg, Laurence Dangers, Olivier Plateker, Cedric Daubin, Lucie Fromont, Charlotte Guesdon, Emmanuel Vivier, Lev Volkov, Cyril Potier, Jeremy Bourenne, Charlotte Chiquet, Valentin Pointurier, Louis Chauvelot, Pierre Bailly, David Schnell, Nicholas Sedillot, Florian Reizine, Laurent Argaud, Faustine Reynaud, Juliette Pelle, Olivier Lesieur, Adrien Auvet, Guillaume Lacave, Marion Kernevez, Damien Contou, Guillaume Grillet, Arnaud Delahaye, Julio Badie, Jerome Devaquet, Hermine Chauvin, Alexandra Beurton, Emanuele Turbil, Jean-Philippe Rigaud, Stéphanie Ragot, Louis Chamblet, Sylvain Le Pape, Rémi Coudroy
A direct tracheostomy without any prior weaning attempt might significantly delay the ventilator weaning process in patients intubated for GBS.
BACKGROUND: Whether or not a direct tracheostomy without any prior weaning attempt is beneficial in patients intubated for Guillain-Barré syndrome (GBS) remains to be determined. Our objective was to determine whether direct tracheostomy results in earlier or later ventilator weaning compared to standard weaning.
METHODS: Multicenter, retrospective cohort study including all patients intubated for GBS over a 10-year period (2014-2023). We compared patients having undergone direct tracheostomy without any prior weaning attempt with those having undergone standard weaning (spontaneous-breathing trial or extubation attempt). We also compared direct tracheostomy with tracheostomy after weaning failure. The primary outcome was the proportion of patients alive and free from mechanical ventilation 28 days after weaning initiation.
RESULTS: Overall, 221 patients (45%) underwent direct tracheostomy and 273 (55%) standard weaning. Compared to patients with standard weaning, those with direct tracheostomy were less likely to be alive and free from mechanical ventilation at day 28 (43% vs. 83%, p < 0.001). Using G-computation to estimate the marginal causal effect of the weaning strategy, standard weaning was more effective than direct tracheostomy in reducing the risk of remaining under mechanical ventilation at day 28: -39.5% [95% Confidence Interval, -47.3% to -31.5%]. Even when compared to patients having undergone tracheostomy after weaning failure, those with direct tracheostomy were less likely to be alive and free from mechanical ventilation 28 days after the tracheostomy procedure.
INTERPRETATION: A direct tracheostomy without any prior weaning attempt might significantly delay the ventilator weaning process in patients intubated for GBS.
CLINICAL TRIAL REGISTRATION: NCT07022028.