Pressure-support ventilation or T-piece spontaneous breathing trials for patients with chronic obstructive pulmonary disease - A randomized controlled trial

Pellegrini, José Augusto Santos; Boniatti, Márcio Manozzo; Boniatti, Viviane Martins Corrêa; Zigiotto, Crislene Cattelan; Viana, Marina Verçoza; Nedel, Wagner Luís; Marques, Leonardo da Silva; Santos, Moreno Calcagnotto dos; Almeida, Clarissa Balbão de; Pizzol, Cláudia Pellizzer Dal; Ziegelmann, Patrícia Klarmann; Vieira, Sílvia Regina Rios

doi:10.1371/journal.pone.0202404

Cited by 16 publications

(38 citation statements)

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“…Sklar et al [3] recently pointed out that PSV significantly reduces the work of breathing and pressure-time product compared to the T-piece, which could, in turn, more closely represent the post-extubation scenario. However, noninvasive mechanical ventilation (NIV) dissemination as an adjunctive for extubation makes clinical interpretation of these data difficult [24]. The major finding of our study suggests that both spontaneous breathing using T-piece and PSV are suitable methods for successful extubation of patients with critical illness from mechanical ventilation.…”

Section: Discussionmentioning

confidence: 91%

“…The search strategy identified 2090 studies, and the data were from 10 RCTs comprising 3165 patients (Table 1) [10,[16][17][18][19][20][21][22][23][24]. The characteristics of the included studies are shown in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Among these studies, 2 studies were conducted in Spain, 2 studies were conducted in Croatia, 2 studies were conducted in Brazil, 1 study was conducted in Korea, 1 study was conducted in Switzerland, 1 study was conducted in Thailand, and 1 study was conducted in China. Of these studies, three were multi-center studies [10,23,24] and seven were single-center studies [15][16][17][18][19][20][21][22]. The interventions of PS and T-Piece included in the meta-analysis are outlined in Table 2.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

Zhang

2020

Crit Care

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Background: The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. A systematic review and meta-analysis was performed to clarify the preferable SBT (T-piece or pressure support ventilation [PSV]). Methods:We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) from inception to the 31st of July 2019. We included RCTs involving adult patients (> 18 years) who underwent at least two different SBT methods. All authors reported our primary outcome of successful extubation rate and clearly compared PS versus T-piece with clinically relevant secondary outcomes (rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results: Ten RCTs including 3165 patients were included. The results of this meta-analysis showed that there was no significant difference in the successful extubation rate between the T-piece group and PS group (odds ratio [OR] = 0.91; 95% CI, 0.78-1.07; P = 0.27; I 2 = 79%). In addition, compared with the PS group, the T-piece group showed no significant difference in the rate of reintubation (odds ratio [OR] = 0.99; 95% CI, 0.78-1.26; P = 0.95; I 2 = 5%), ICU mortality (odds ratio [OR] = 1.22; 95% CI, 0.83-1.80; P = 0.30; I 2 = 0%), hospital mortality (odds ratio [OR] = 1.36; 95% CI, 0.99-1.87; P = 0.06; I 2 = 19%), ICU length of stay (mean difference = − 0.10; 95% CI, − 0.59 to 0.39; P = 0.69; I 2 = 13%), and hospital length of stay (mean difference = − 0.82;95% CI, − 2.2 to 0.55; P = 0.24; I 2 = 0%). Conclusions: T-piece and PSV as SBTs are considered to have comparable predictive power of successful extubation in critically ill patients. The analysis of secondary outcomes also shows no significant difference in the rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality between the two groups. Further randomized controlled studies of SBTs are still required.

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Section: Discussionmentioning

confidence: 91%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

Zhang

2020

Crit Care

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“…A total of 99 patients met the inclusion criteria and all were recruited into the study (Figure 3). The eligible patients were male (50.51%) with the median age of 70 [23]…”

Section: Study Participantsmentioning

confidence: 99%

“…Practically, SBT is considered as a standard and effective weaning method 16,17 which consists of low-level pressure support ventilation (PSV) and T-piece. The majority of previous randomized controlled trials of different weaning methods demonstrated the similar extubation outcomes between the PSV and T-piece 18,19,[21][22][23][24][25] . In contrast, the recent multicenter study from Spain 27 showed a significantly higher rate of successful extubation in the PSV, compared with the T-piece (82.3% in the PSV group and 74% in the T-piece group, p=0.001) but showed the similar rates of reintubation (11.1% in the PSV group and 11.9% in the T-piece group, p=0.630).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Success Rate of Extubation Between Spontaneous Breathing Trial with Pressure Support Ventilation and T-piece in Patients with Expiratory Flow Limitation

Kluanwan

Kongpolprom

2021

Preprint

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Background: Expiratory flow limitation (EFL) is an inability to exceed a certain flow regardless of the pressure exerted, which appears in 60% of patients with extubation failure. However, an appropriate weaning method for the patients with EFL remains unknown. Objectives: We aimed to evaluate an effect of different techniques of spontaneous breathing trials (SBT) on a success rate of extubation in the patients with EFL. Methods: We conducted a non-inferiority randomized controlled trial comparing between 30-minute pressure support ventilation (PSV) and 30-minute T-piece in ventilated patients with EFL who got ready to wean. The primary outcome was successful extubation during a 72-hour post-extubation period. Secondary outcomes were a reintubation rate within 7 days, time to reintubation, and a SBT success rate. Results: A total of 99 ventilated patients with EFL consisting of male (50.5%) with the median age of 70 [23] years were recruited. The most common cause of acute respiratory failure was intrapulmonary cause (68.7%). The eligible patients were randomized into 2 groups with a ratio of 1:1. The success rate of extubation during the 72-hour period in the PSV group was non-inferior to the T-piece group: 82% and 81.63%, respectively (95%CI -0.148 to 0.156, p=0.0475). There was also non-inferiority in the reintubation rate within 7 days (22.9% in the PSV group VS 15.2% in the T-piece group; 95%CI -0.081 to 0.235, p=0.005) and the SBT success rate (96% in the PSV group VS 93.9% in the T-piece group; 95%CI -0.065 to 0.108, p<0.001). There was no significant difference in the median time to reintubation between these 2 groups (55 [95.5] hours in PSV VS 25.33 [48] hours in the T-piece group, p=0.683). Conclusions: Among patients with EFL, the 30-minute SBT with PSV was non-inferior to the T-piece SBT in terms of the successful extubation during the 72-hour period, successful SBT, and reintubation rate within 7 days. This was the first study demonstrating that the different techniques of SBT did not affect the weaning outcomes in the patients with EFL.

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Spontaneous Breathing Trial Techniques for Extubating Adults and Children Who Are Critically Ill

Burns,

Khan,

Phoophiboon

et al. 2024

JAMA Netw Open

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ImportanceConsiderable controversy exists regarding the best spontaneous breathing trial (SBT) technique to use.ObjectiveTo summarize trials comparing alternative SBTs.Data SourcesSeveral 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 SelectionRandomized trials directly comparing SBT techniques in critically ill adults or children and reporting at least 1 clinical outcome were selected.Data Extraction and SynthesisPaired 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 MeasuresPrimary outcomes included SBT success, extubation success, and reintubation.ResultsThe 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 &lt; .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 &lt; .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 = &lt;.001; I2 = 0% [both low-quality evidence]) rates. Credible subgroup effects were not found.Conclusions and RelevanceIn 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.

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Pressure-support ventilation or T-piece spontaneous breathing trials for patients with chronic obstructive pulmonary disease - A randomized controlled trial

Cited by 16 publications

References 32 publications

Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

Comparison of Success Rate of Extubation Between Spontaneous Breathing Trial with Pressure Support Ventilation and T-piece in Patients with Expiratory Flow Limitation

Spontaneous Breathing Trial Techniques for Extubating Adults and Children Who Are Critically Ill

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