Comparison of Pressure Support Ventilation and T-piece in Determining Rapid Shallow Breathing Index in Spontaneous Breathing Trials

Zhang, Bo; Qin, Ying-zhi

doi:10.1097/maj.0000000000000286

Cited by 27 publications

(32 citation statements)

References 18 publications

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“…Thirty-one trials [18–48] reporting on 3541 patients met our inclusion criteria including five trials comparing three SBT techniques [23, 24, 29, 30, 48]. Two trials [38, 46] appeared to be published, at least in part, in duplicate [49, 50]. The most common comparisons were T-piece vs PS (13 trials), T-piece vs CPAP (nine trials), PS vs ATC (three trials), and CPAP vs ATC (three trials).…”

Section: Resultsmentioning

confidence: 99%

Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis

et al. 2017

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BackgroundThe effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain.MethodsWe searched MEDLINE, EMBASE, CENTRAL, CINAHL, Evidence-Based Medicine Reviews, Ovid Health Star, proceedings of five conferences (1990–2016), and reference lists for randomized trials comparing SBT techniques in intubated adults or children. Primary outcomes were initial SBT success, extubation success, or reintubation. Two reviewers independently screened citations, assessed trial quality, and abstracted data.ResultsWe identified 31 trials (n = 3541 patients). Moderate-quality evidence showed that patients undergoing pressure support (PS) compared with T-piece SBTs (nine trials, n = 1901) were as likely to pass an initial SBT (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.89–1.11; I 2 = 77%) but more likely to be ultimately extubated successfully (RR 1.06, 95% CI 1.02–1.10; 11 trials, n = 1904; I 2 = 0%). Exclusion of one trial with inconsistent results for SBT and extubation outcomes suggested that PS (vs T-piece) SBTs also improved initial SBT success (RR 1.06, 95% CI 1.01–1.12; I 2 = 0%). Limited data suggest that automatic tube compensation plus continuous positive airway pressure (CPAP) vs CPAP alone or PS increase SBT but not extubation success.ConclusionsPatients undergoing PS (vs T-piece) SBTs appear to be 6% (95% CI 2–10%) more likely to be extubated successfully and, if the results of an outlier trial are excluded, 6% (95% CI 1–12%) more likely to pass an SBT. Future trials should investigate patients for whom SBT and extubation outcomes are uncertain and compare techniques that maximize differences in support.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1698-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis

et al. 2017

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“…Breathing pattern during SBTs under minimal ventilatory support (eg, CPAP or PSV) may reduce the predictive performance of breathing pattern variability. 24,43 Although P I max , RSBI, RSBI 1 , RSBI 30 , and ⌬RSBI 30 were not used as the input parameters for the ANN model, the prediction performance of the ANN model was more precise than any one of them. This result may indicate that more clinical parameters from the subject should be taken into consideration during an SBT before extubation.…”

Section: Discussionmentioning

confidence: 99%

Improvement in the Prediction of Ventilator Weaning Outcomes by an Artificial Neural Network in a Medical ICU

et al. 2015

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“…The search strategy identified 2090 studies, and the data were from 10 RCTs comprising 3165 patients (Table 1) [10,[16][17][18][19][20][21][22][23][24]. The characteristics of the included studies are shown in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Among these studies, 2 studies were conducted in Spain, 2 studies were conducted in Croatia, 2 studies were conducted in Brazil, 1 study was conducted in Korea, 1 study was conducted in Switzerland, 1 study was conducted in Thailand, and 1 study was conducted in China. Of these studies, three were multi-center studies [10,23,24] and seven were single-center studies [15][16][17][18][19][20][21][22]. The interventions of PS and T-Piece included in the meta-analysis are outlined in Table 2.…”

Section: Study Characteristicsmentioning

confidence: 99%

Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

Zhang

2020

Crit Care

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Background: The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. A systematic review and meta-analysis was performed to clarify the preferable SBT (T-piece or pressure support ventilation [PSV]). Methods:We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) from inception to the 31st of July 2019. We included RCTs involving adult patients (> 18 years) who underwent at least two different SBT methods. All authors reported our primary outcome of successful extubation rate and clearly compared PS versus T-piece with clinically relevant secondary outcomes (rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results: Ten RCTs including 3165 patients were included. The results of this meta-analysis showed that there was no significant difference in the successful extubation rate between the T-piece group and PS group (odds ratio [OR] = 0.91; 95% CI, 0.78-1.07; P = 0.27; I 2 = 79%). In addition, compared with the PS group, the T-piece group showed no significant difference in the rate of reintubation (odds ratio [OR] = 0.99; 95% CI, 0.78-1.26; P = 0.95; I 2 = 5%), ICU mortality (odds ratio [OR] = 1.22; 95% CI, 0.83-1.80; P = 0.30; I 2 = 0%), hospital mortality (odds ratio [OR] = 1.36; 95% CI, 0.99-1.87; P = 0.06; I 2 = 19%), ICU length of stay (mean difference = − 0.10; 95% CI, − 0.59 to 0.39; P = 0.69; I 2 = 13%), and hospital length of stay (mean difference = − 0.82;95% CI, − 2.2 to 0.55; P = 0.24; I 2 = 0%). Conclusions: T-piece and PSV as SBTs are considered to have comparable predictive power of successful extubation in critically ill patients. The analysis of secondary outcomes also shows no significant difference in the rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality between the two groups. Further randomized controlled studies of SBTs are still required.

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Comparison of Pressure Support Ventilation and T-piece in Determining Rapid Shallow Breathing Index in Spontaneous Breathing Trials

Cited by 27 publications

References 18 publications

Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis

Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis

Improvement in the Prediction of Ventilator Weaning Outcomes by an Artificial Neural Network in a Medical ICU

Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

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