Pressure support versus T-tube for weaning from mechanical ventilation in adults

Abstract

Cochrane Database of Systematic Reviews Data collection and analysisTwo authors extracted data and assessed the methodological quality of the included studies. Meta-analyses using the random-e ects model were conducted for nine outcomes. Relative risk (RR) and mean di erence (MD) or standardized mean di erence (SMD) were used to estimate the treatment e ect, with 95% confidence intervals (CI).

Strategies for weaning from mechanical ventilation: A state of the art review

“…A SBT generally comprises 30-60 minutes on either low levels of pressure support or continuous positive airway pressure (CPAP) via the ventilator, or using a T-piece attached to the endotracheal tube. A recent Cochrane systematic review and meta-analysis confirms the results of earlier studies that report no difference in terms of weaning success based on the SBT method (Ladeira et al, 2014). Most patients, approximately 60-70%, will require minimal to no weaning of ventilatory support and are extubated without difficulty after the first SBT (Boles et al, 2007).…”

Underestimation of Patient Breathlessness by Nurses and Physicians during a Spontaneous Breathing Trial

“…The SBT was performed by pressure supported (PS) ventilation 6-8 cmH 2 O with PEEP of 6-8 cmH 2 O (SERVOi or Engström Carestation ventilator), a T-piece, or external CPAP with PEEP 5 cmH 2 O. The three SBTmethods are in clinically use to assess readiness for extubation (5,18). At the end of a SBT, a nurse and a physician individually rated the patient for breathlessness.…”

Discontinuation of ventilatory support

“…The relative efficacy of these methods has been poorly evaluated. Recently, a Cochrane systematic review including nine randomized clinical trials (RCTs) with 1208 patients showed no clear evidence of a difference between PSV and T-tube for weaning success [32]. Data from an international, prospective, and multicenter study with 927 participating ICUs and 18 302 patients undergoing mechanical ventilation for more than 12 h [33 && ] showed that the proportion of patients who successfully completed their first SBT increased over time (49% in 1998, 55% in 2004, and 63.5% in 2010, P < 0.001).…”