Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis
Open Access
- 1 June 2017
- journal article
- research article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 21 (1), 127
- https://doi.org/10.1186/s13054-017-1698-x
Abstract
Background The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. Methods We searched MEDLINE, EMBASE, CENTRAL, CINAHL, Evidence-Based Medicine Reviews, Ovid Health Star, proceedings of five conferences (1990–2016), and reference lists for randomized trials comparing SBT techniques in intubated adults or children. Primary outcomes were initial SBT success, extubation success, or reintubation. Two reviewers independently screened citations, assessed trial quality, and abstracted data. Results We identified 31 trials (n = 3541 patients). Moderate-quality evidence showed that patients undergoing pressure support (PS) compared with T-piece SBTs (nine trials, n = 1901) were as likely to pass an initial SBT (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.89–1.11; I 2 = 77%) but more likely to be ultimately extubated successfully (RR 1.06, 95% CI 1.02–1.10; 11 trials, n = 1904; I 2 = 0%). Exclusion of one trial with inconsistent results for SBT and extubation outcomes suggested that PS (vs T-piece) SBTs also improved initial SBT success (RR 1.06, 95% CI 1.01–1.12; I 2 = 0%). Limited data suggest that automatic tube compensation plus continuous positive airway pressure (CPAP) vs CPAP alone or PS increase SBT but not extubation success. Conclusions Patients undergoing PS (vs T-piece) SBTs appear to be 6% (95% CI 2–10%) more likely to be extubated successfully and, if the results of an outlier trial are excluded, 6% (95% CI 1–12%) more likely to pass an SBT. Future trials should investigate patients for whom SBT and extubation outcomes are uncertain and compare techniques that maximize differences in support.Keywords
This publication has 58 references indexed in Scilit:
- Meta-Analysis and SubgroupsPrevention Science, 2013
- Automatic Tube Compensation versus Pressure Support Ventilation and Extubation Outcome in Children: A Randomized Controlled StudyISRN Pediatrics, 2013
- Prediction of extubation outcome: a randomised, controlled trial with automatic tube compensation vs. pressure support ventilationCritical Care, 2009
- What is “quality of evidence” and why is it important to clinicians?BMJ, 2008
- Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressureCritical Care Medicine, 2006
- Breathing pattern and workload during automatic tube compensation, pressure support and T-piece trials in weaning patientsEuropean Journal of Anaesthesiology, 2003
- Breathing pattern and workload during automatic tube compensation, pressure support and T-piece trials in weaning patientsEuropean Journal of Anaesthesiology, 2003
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- The role of continuous positive airway pressure during weaning from mechanical ventilation in cardiac surgical patientsAnaesthesia, 1995
- PRESSURE SUPPORT VENTILATION IN COMBINATION WITH CONTINUOUS POSITIVE AIRWAY PRESSURE IS A BETTER WEANING TRIAL IN THE POST CORONARY BYPASS PATIENT.Critical Care Medicine, 1995