Effect of aggressive vs conservative screening and confirmatory test on time to extubation among patients at low or intermediate risk: a randomized clinical trial.

Purpose: This study aimed to determine the best strategy to achieve fast and safe extubation.

Methods: This multicenter trial randomized patients with primary respiratory failure and low-to-intermediate risk for extubation failure with planned high-flow nasal cannula (HFNC) preventive therapy. It included four groups: (1) conservative screening with ratio of partial pressure of arterial oxygen (PaO) to fraction of inspired oxygen (FiO) ≥ 150 and positive end-expiratory pressure (PEEP) ≤ 8 cmHO plus conservative spontaneous breathing trial (SBT) with pressure support 5 cmHO + PEEP 0 cmHO); (2) screening with ratio of partial pressure of arterial oxygen (PaO) to fraction of inspired oxygen (FiO) ≥ 150 and PEEP ≤ 8 plus aggressive SBT with pressure support 8 + PEEP 5; (3) aggressive screening with PaO/FiO > 180 and PEEP 10 maintained until the SBT with pressure support 8 + PEEP 5; (4) screening with PaO/FiO > 180 and PEEP 10 maintained until the SBT with pressure support 5 + PEEP 0.