We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Spontaneous Breathing Trial Techniques for Extubating Adults and Children Who Are Critically Ill: A Systematic Review and Meta-Analysis.
- Authors
Burns, Karen E. A.; Khan, Jeena; Phoophiboon, Vorakamol; Trivedi, Vatsal; Gomez-Builes, J. Carolina; Giammarioli, Benedetta; Lewis, Kimberley; Chaudhuri, Dipayan; Desai, Kairavi; Friedrich, Jan O.
- Abstract
Key Points: Question: Which spontaneous breathing trial (SBT) technique is associated with more successful SBTs and successful extubations among adults and children who are critically ill? Findings: In this systematic review and meta-analysis that included 6716 critically ill adults and children, patients undergoing pressure support compared with T-piece SBTs were more likely to be extubated successfully and more likely to pass an SBT if the results of an outlier trial were excluded. Meaning: These findings suggest that pressure support (vs T-piece) SBTs are associated with more successful extubations without increasing risk of reintubation. Importance: Considerable controversy exists regarding the best spontaneous breathing trial (SBT) technique to use. Objective: To summarize trials comparing alternative SBTs. Data Sources: Several databases (MEDLINE [from inception to February 2023], the Cochrane Central Register of Controlled Trials [in February 2023], and Embase [from inception to February 2023] and 5 conference proceedings (from January 1990 to April 2023) were searched in this systematic review and meta-analysis. Study Selection: Randomized trials directly comparing SBT techniques in critically ill adults or children and reporting at least 1 clinical outcome were selected. Data Extraction and Synthesis: Paired reviewers independently screened citations, abstracted data, and assessed quality for the systematic review and meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA guidelines). Data were pooled using random-effects models. Main Outcomes and Measures: Primary outcomes included SBT success, extubation success, and reintubation. Results: The systematic review and meta-analysis identified 40 trials that included 6716 patients. Low-quality evidence (14 trials [n = 4459]) suggested that patients were not more likely to pass a pressure support (PS) compared with a T-piece SBT (risk ratio [RR], 1.04; 95% CI, 0.97-1.11; P =.31; I2 = 73%), unless 1 outlier trial accounting for all heterogeneity was excluded (RR, 1.09; 95% CI, 1.06-1.12; P <.001; I2 = 0% [13 trials; n = 3939]; moderate-quality evidence), but were significantly more likely to be successfully extubated (RR, 1.07; 95% CI, 1.04-1.10; P <.001; I2 = 0%; 16 trials [n = 4462]; moderate-quality evidence). Limited data (5 trials [n = 502]) revealed that patients who underwent automatic tube compensation/continuous positive airway pressure compared with PS SBTs had a significantly higher successful extubation rate (RR, 1.10; 95% CI, 1.00-1.21; P =.04; I2 = 0% [low-quality evidence]). Compared with T-piece SBTs, high-flow oxygen SBTs (3 trials [n = 386]) had significantly higher successful extubation (RR, 1.06; 95% CI, 1.00-1.11; P =.04; I2 = 0%) and lower reintubation (RR, 0.37; 95% CI, 0.21-0.65; P = <.001; I2 = 0% [both low-quality evidence]) rates. Credible subgroup effects were not found. Conclusions and Relevance: In this systematic review and meta-analysis, the findings suggest that patients undergoing PS compared with T-piece SBTs were more likely to be extubated successfully and more likely to pass an SBT, after exclusion of an outlier trial. Pressure support SBTs were not associated with increased risk of reintubation. Future trials should compare SBT techniques that maximize differences in inspiratory support. This systematic review and meta-analysis evaluates which spontaneous breathing trial (SBT) technique is associated with more successful SBTs and extubations and risk of reintubations among critically ill adults and children.
- Subjects
MEDICAL databases; META-analysis; MEDICAL information storage &; retrieval systems; CONFIDENCE intervals; CRITICALLY ill; SYSTEMATIC reviews; CONTINUOUS positive airway pressure; PATIENTS; EXTUBATION; CATASTROPHIC illness; DESCRIPTIVE statistics; CHI-squared test; VENTILATOR weaning; MEDLINE
- Publication
JAMA Network Open, 2024, Vol 7, Issue 2, pe2356794
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.56794