Role of Automatic Tube Compensation as Spontaneous Breathing Trial in Critically Ill Patients: A Systematic Review and Meta-Analysis

Abstract

Objectives: The role of automatic tube compensation (ATC) compared to other spontaneous breathing trials (SBTs) in critically ill receiving mechanical ventilation remains uncertain. The aim of this meta-analysis was to determine the role of ATC in critically ill patients compared to alternative SBT techniques. Methods: We searched PubMed, Cochrane Library, and Embase to capture all potential randomized controlled trials (RCTs) investigating the comparative efficacy of ATC related to other SBT techniques including pressure support (PS), T-piece, continuous positive airway pressure (CPAP) from their inception to February 2020. Primary outcomes were successful extubation rate. Duration of weaning, intensive care unit (ICU) stay, hospital stay, and hospital mortality was regarded as secondary outcomes. We used a risk ratio with accompanying 95% confidence interval (CI) to express estimates. Reviewer Manager (RevMan) 5.1.0 was used to complete all statistical analyses. Results: We included 13 studies enrolling 1117 patients in the final analysis. Pooled results indicated no significant difference when ATC plus CPAP (ATC/CAPA) compared to PS (6 RCTs; 572 patients; risk ratio [RR], 1.15; 95% confidence interval [CI], 1.00 to 1.31), ATC versus T-piece (2 RCTs; 157 patients; RR, 1.14; 95% CI, 0.93 to 1.40), ATC plus PS (ATC/PS) versus PS alone (1 RCTs; 100 patients; RR, 1.15; 95% CI, 0.98 to 1.35), ATC/CPAP versus CPAP alone (3 RCTs; 247 patients; RR, 1.12; 95% CI, 0.97 to 1.29) in terms of successful extubation. Additionally, ATC was also not superior to PS, T-piece, or CPAP in improving the rate of reintubation, the duration of weaning, ICU stay, hospital stay, and hospital mortality. Conclusions: Compared to alternative SBT techniques including PSV and T-piece, ATC may have comparable predictive power of successful extubation in critically ill patients. However, a definite conclusion on this topic can not be drawn due to limited data. Therefore, further studies were required to establish our findings due to limited number of eligible studies and small accumulated sample size.