Spontaneous Breathing Trials With T-Piece or Pressure Support Ventilation.
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.
Division of Critical Care, Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil. joseaugusto.pellegrini@gmail.com.|Division of Critical Care, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
José Augusto S
JA
Pellegrini
Division of Critical Care, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
Rafael B
RB
Moraes
Division of Critical Care, Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil.
Juçara G
JG
Maccari
Division of Critical Care, Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil.|Medical School, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
Roselaine P
RP
de Oliveira
Division of Critical Care, Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil.
Augusto
A
Savi
Institute for Education and Research, HMV, Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Rodrigo A
RA
Ribeiro
Interdepartmental Division of Critical Care Medicine, St. Michael's Hospital and the University of Toronto and the Li Ka Shing Knowledge Institute, Toronto, Canada.
Karen Ea
KE
Burns
Division of Critical Care, Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil.|Medical School, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
Cassiano
C
Teixeira
D000328:Adult; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012119:Respiration; D012129:Respiratory Function Tests / Q000295:instrumentation / Q000379:methods; D013997:Time Factors; D015300:Ventilator Weaning / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data
critical care; mechanical ventilation; weaning