Comparison between T-piece or CPAP and pressure support ventilation in spontaneous breathing trials: a systematic review and meta-analysis

Abstract

Background The ideal time to wean off of a ventilator has been predicted using the spontaneous breathing trial (SBT). Which trial ought to be chosen with preference is still debatable. Among critically sick patients receiving mechanical ventilation (MV) our goal was to evaluate typical SBT modalities such as pressure support ventilation (PSV), continuous positive airway pressure (CPAP), and T-piece. Methods We searched the PubMed, Cochrane, Embase, Web of Science database for RCTs from inception to the 30th of Nov. 2022. We included RCTs involving adult patients (> 18 years) who underwent at least two different SBT methods. Primary outcome was extubation. Secondary outcomes were reintubation, mechanical ventilation duration, intensive care unit (ICU) mortality, and hospital mortality, intensive care unit (ICU) length of stay and hospital length of stay. Statistical analysis was conducted by using RevMan 5.4 and trial sequence analysis (TSA). Results were expressed as risk ratio (RR) or mean difference (MD) with accompanying 95% confidence interval (CI). Results Twenty-one RCTs comprising 4636 patients are included. The results of this meta-analysis showed that there was a significant difference in the successful extubation rate between the T-piece or CPAP group and PSV group (risk ratio [RR] = 0.93; 95% CI, 0.90–0.96; P < 0.00001; Chi2 = 7.86; I2 = 0%). In addition, there was statistically difference in the hospital mortality between 2 groups (risk ratio [RR] = 1.23; 95% CI, 1.01–1.49; P = 0.04; ChI2 = 3.07; I2 = 0%). Compared with the PS group, the T-piece or CPAP group showed no significant difference in other secondary outcomes. Further subgroup analysis found that the duration of mechanical ventilation appeared to be shorter in the PSV group than in the T-piece group in patients with difficult weaning. Conclusions The prognostic power of T-piece, CPAP, and PSV as SBTs for effective extubation in critically ill patients is seen as being equivalent. PSV has the potential to increase the success rate of patient extubation when compared to T-piece or CPAP. In addition, the PSV group appeared to have an advantage over the other group in lowering hospital mortality and cutting the time those patients with difficult weaning.