“…1). Thirty-one trials [18–48] reporting on 3541 patients met our inclusion criteria including five trials comparing three SBT techniques [23, 24, 29, 30, 48]. Two trials [38, 46] appeared to be published, at least in part, in duplicate [49, 50].…”
Section: Resultsmentioning
confidence: 99%
“…Six trials [25, 27, 33, 36, 45, 47] were published as abstracts, of which two [36, 47] provided partial or full-text manuscripts. Nine trials [19–21, 23–25, 44, 45, 47] evaluated perioperative populations (six cardiac surgical [19–21, 24, 25, 44] and three other surgical [23, 45, 47]). Three trials [28, 43, 46] evaluated pediatric patients.Fig.…”
BackgroundThe effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain.MethodsWe 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.ResultsWe 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.ConclusionsPatients 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1698-x) contains supplementary material, which is available to authorized users.
“…1). Thirty-one trials [18–48] reporting on 3541 patients met our inclusion criteria including five trials comparing three SBT techniques [23, 24, 29, 30, 48]. Two trials [38, 46] appeared to be published, at least in part, in duplicate [49, 50].…”
Section: Resultsmentioning
confidence: 99%
“…Six trials [25, 27, 33, 36, 45, 47] were published as abstracts, of which two [36, 47] provided partial or full-text manuscripts. Nine trials [19–21, 23–25, 44, 45, 47] evaluated perioperative populations (six cardiac surgical [19–21, 24, 25, 44] and three other surgical [23, 45, 47]). Three trials [28, 43, 46] evaluated pediatric patients.Fig.…”
BackgroundThe effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain.MethodsWe 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.ResultsWe 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.ConclusionsPatients 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1698-x) contains supplementary material, which is available to authorized users.
“…Patients in their study may be compared with our patients because the optimum pre-extubation mode of ventilation and duration of the SBT has not yet been identified [23]. SBT (30-120 min) using low-level PSV compared with T piece [24,25], low-level PEEP compared with a T piece [26,27], and PSV 5 cmH 2 O with PEEP 5 cmH 2 O for a f/V T ratio ratio of spontaneous breathing frequency to tidal volume, MV exhaled spontaneous minute ventilation, PaO 2 /FIO 2 ratio ratio of partial pressure arterial oxygen to fractional inhaled oxygen concentration, VCO 2 lung carbon dioxide elimination rate per minute (carbon dioxide minute production), V D /V T ratio ratio of physiologic dead space volume to tidal volume, Crs respiratory system compliance timed trial [28] (as used in our study) were found to be equally effective, suitable methods for assessing readiness for extubation. Fiastro et al [29] compared work of breathing during SBT through a T piece to traditional indices like V T , MV, negative inspiratory pressure (NIP), and vital capacity for extubation in adults in a combined medical and surgical ICU.…”
WOB(N)/min had the greatest overall predictive accuracy for extubation compared to traditional indices. WOB(N)/min warrants consideration for use in a complementary manner with spontaneous breathing pattern data for predicting extubation outcome.
“…FEELEY et al [141], in a randomised controlled trial, concluded that PEEP in spontaneously breathing patients may be helpful during weaning of patients with primarily hypoxic respiratory failure. In cardiac surgical patients, typically included in the previously discussed weaning group 1, BAILEY et al [142] randomised patients to receive CPAP or T-piece trials prior to extubation and observed no significant difference in oxygenation or time spent on mechanical ventilation. Others have hypothesised that the use of CPAP during weaning may be helpful to prevent immediate postextubation hypoxaemia; however, compared to T-piece trials no clear improvement in outcomes has been observed.…”
Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Many controversial questions remain concerning the best methods for conducting this process. An International Consensus Conference was held in April 2005 to provide recommendations regarding the management of this process. An 11-member international jury answered five pre-defined questions. 1) What is known about the epidemiology of weaning problems? 2) What is the pathophysiology of weaning failure? 3) What is the usual process of initial weaning from the ventilator? 4) Is there a role for different ventilator modes in more difficult weaning? 5) How should patients with prolonged weaning failure be managed?The main recommendations were as follows. 1) Patients should be categorised into three groups based on the difficulty and duration of the weaning process. 2) Weaning should be considered as early as possible. 3) A spontaneous breathing trial is the major diagnostic test to determine whether patients can be successfully extubated. 4) The initial trial should last 30 min and consist of either T-tube breathing or low levels of pressure support. 5) Pressure support or assist–control ventilation modes should be favoured in patients failing an initial trial/trials. 6) Noninvasive ventilation techniques should be considered in selected patients to shorten the duration of intubation but should not be routinely used as a tool for extubation failure.
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