RT Journal Article
SR Electronic
T1 Spontaneous Breathing Trials With T-Piece or Pressure Support Ventilation
JF Respiratory Care
FD American Association for Respiratory Care
SP 1693
OP 1703
DO 10.4187/respcare.04816
VO 61
IS 12
A1 José Augusto S Pellegrini
A1 Rafael B Moraes
A1 Juçara G Maccari
A1 Roselaine P de Oliveira
A1 Augusto Savi
A1 Rodrigo A Ribeiro
A1 Karen EA Burns
A1 Cassiano Teixeira
YR 2016
UL http://rc.rcjournal.com/content/61/12/1693.abstract
AB Spontaneous breathing trials (SBTs) are among the most commonly employed techniques to facilitate weaning from mechanical ventilation. The preferred SBT technique, however, is still unclear. To clarify the preferable SBT (T-piece or pressure support ventilation [PSV]), we conducted this systematic review. We then searched the MEDLINE, EMBASE, SciELO, Google Scholar, CINAHL, ClinicalTrials.gov, and Cochrane CENTRAL databases through June 2015, without language restrictions. We included randomized controlled trials involving adult subjects being weaned from mechanical ventilation comparing T-piece with PSV and reporting (1) weaning failure, (2) re-intubation rate, (3) ICU mortality, or (4) weaning duration. Anticipating clinical heterogeneity among the included studies, we compared prespecified subgroups: (1) simple, difficult, or prolonged weaning and (2) subjects with COPD. We summarized the quality of evidence for intervention effects using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. We identified 3,674 potentially relevant studies and reviewed 23 papers in full. Twelve studies (2,161 subjects) met our inclusion criteria. Overall, the evidence was of very low to low quality. SBT technique did not influence weaning success (risk ratio 1.23 [0.94–1.61]), ICU mortality (risk ratio 1.11 [0.80–1.54]), or re-intubation rate (risk ratio 1.21 [0.90–1.63]). Prespecified subgroup analysis suggested that PSV might be superior to T-piece with regard to weaning success for simple-to-wean subjects (risk ratio 1.44 [1.11–1.86]). For the prolonged-weaning subgroup, however, T-piece was associated with a shorter weaning duration (weighted mean difference −3.08 [−5.24 to −0.92] d). In conclusion, low-quality evidence is available concerning this topic. PSV may be associated with lower weaning failure rates in the simple-to-wean subgroup. In contrast, in prolonged-weaning subjects, T-piece may be related to a shorter weaning duration, although this is at high risk of bias. Further study of the difficult-to-wean and COPD subgroups is required.