Trials comparing alternative weaning modes and discontinuation assessments.
We identified 16 randomized controlled trials (RCTs) of methods for weaning patients from mechanical ventilation, 8 of which were trials of discontinuation assessment strategies, 5 of which were trials of stepwise reduction in mechanical ventilatory support, and 3 of which were trials comparing alternative ventilation modes for weaning periods lasting < 48 h. We found that different thresholds for deciding when a patient is ready for a trial of spontaneous breathing, different criteria for a successful trial, and different thresholds for extubation may overwhelm the impact of alternative ventilation strategies. Nevertheless, the results of these studies suggest the possibility that multiple daily T-piece weaning or pressure support may be superior to synchronized intermittent mandatory ventilation. Other RCTs suggest that early extubation with the back-up institution of noninvasive positive-pressure ventilation as needed may be a useful strategy in selected patients.
Meade
M
M
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Guyatt
G
G
Sinuff
T
T
Griffith
L
L
Hand
L
L
Toprani
G
G
Cook
D J
DJ
D019317:Evidence-Based Medicine; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods