Automatic Tube Compensation During Spontaneous Breathing Trial

BACKGROUND: Automatic tube compensation (ATC) is an option available in any ICU ventilator that compensates for the resistive pressure drop due to the endotracheal tube by providing flow assistance. The goal of the present study was to compare ATC to other patient triggered modes of support in terms of spontaneous breathing trial (SBT) and extubation success.

METHODS: Two authors (JB and PCF), independently and blinded to each other, searched through PubMed, Web of Science, and Cochrane from inception–May 26, 2021, with the following search terms entered as MeSH terms in all fields: “Automatic Tube Compensation.” Inclusion criteria: randomized studies that included subjects > 16 y old undergoing an SBT. Exclusion criteria: crossover studies, pediatric studies, animal studies, or experimental studies on test lungs or on computer simulation; other languages than French, Spanish, or English; studies not published in a full-text format (eg, abstract or letter); and reviews. A frequentist network meta-analysis was conducted with the aim to investigate the effectiveness of ATC on SBT and extubation outcomes. SBT was defined as successful if patients could tolerate the SBT based on predetermined criteria, whether it was followed by extubation. Successful extubation was defined as the absence of re-intubation, noninvasive ventilation, or signs of respiratory distress within the 48 h after extubation. The pooled analyses used random-effect models, and the effect size was expressed as relative risk or mean difference for categorical and continuous variables, respectively. P-scores were used to rank all treatments and to identify the intervention with the highest probability of being the best.

RESULTS: Of the 234 retrieved papers, 7 met the inclusion criteria. In terms of SBT success, ATC100+PEEP < 7.5 and PS10+PEEP < 7.5 were superior to T-piece. Likewise, PS10+PEEP < 7.5 was the intervention with the highest probability of being the best (P-score: 0.90). In terms of extubation success, ATC100+PEEP < 7.5 cm H₂O was significantly better than PEEP < 7.5 and T-piece. Likewise, it had the highest probability of being the best (P-score= 0.90).

CONCLUSIONS: ATC is the modality with the highest probability of being the best in terms of extubation success but not in terms of SBT success.