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Comparative effectiveness of alternative spontaneous breathing trial techniques: a systematic review and network meta-analysis of randomized trials.
Burns, Karen E A; Sadeghirad, Behnam; Ghadimi, Maryam; Khan, Jeena; Phoophiboon, Vorakamol; Trivedi, Vatsal; Gomez Builes, Carolina; Giammarioli, Benedetta; Lewis, Kimberley; Chaudhuri, Dipayan; Desai, Kairavi; Friedrich, Jan O.
Afiliación
  • Burns KEA; Departments of Critical Care Medicine and Medicine, Unity Health Toronto, St. Michael's Hospital, 30 Bond Street, 4-045 Donnelly Wing, Toronto, ON, M5B 1W8, Canada. Karen.burns@unityhealth.to.
  • Sadeghirad B; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. Karen.burns@unityhealth.to.
  • Ghadimi M; Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, Canada. Karen.burns@unityhealth.to.
  • Khan J; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. Karen.burns@unityhealth.to.
  • Phoophiboon V; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
  • Trivedi V; Departments of Anesthesia and Medicine, McMaster University, Hamilton, Canada.
  • Gomez Builes C; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
  • Giammarioli B; Departments of Critical Care Medicine and Medicine, Unity Health Toronto, St. Michael's Hospital, 30 Bond Street, 4-045 Donnelly Wing, Toronto, ON, M5B 1W8, Canada.
  • Lewis K; Royal College of Surgeons of Ireland, University of Medicine and Health Sciences, Dublin, Ireland.
  • Chaudhuri D; Departments of Critical Care Medicine and Medicine, Unity Health Toronto, St. Michael's Hospital, 30 Bond Street, 4-045 Donnelly Wing, Toronto, ON, M5B 1W8, Canada.
  • Desai K; Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
  • Friedrich JO; Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada.
Crit Care ; 28(1): 194, 2024 06 08.
Article en En | MEDLINE | ID: mdl-38849936
ABSTRACT

BACKGROUND:

The spontaneous breathing trial (SBT) technique that best balance successful extubation with the risk for reintubation is unknown. We sought to determine the comparative efficacy and safety of alternative SBT techniques.

METHODS:

We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to February 2023 for randomized or quasi-randomized trials comparing SBT techniques in critically ill adults and children and reported initial SBT success, successful extubation, reintubation (primary outcomes) and mortality (ICU, hospital, most protracted; secondary outcome) rates. Two reviewers screened, reviewed full-texts, and abstracted data. We performed frequentist random-effects network meta-analysis.

RESULTS:

We included 40 RCTs (6716 patients). Pressure Support (PS) versus T-piece SBTs was the most common comparison. Initial successful SBT rates were increased with PS [risk ratio (RR) 1.08, 95% confidence interval (CI) (1.05-1.11)], PS/automatic tube compensation (ATC) [1.12 (1.01 -1.25), high flow nasal cannulae (HFNC) [1.07 (1.00-1.13) (all moderate certainty), and ATC [RR 1.11, (1.03-1.20); low certainty] SBTs compared to T-piece SBTs. Similarly, initial successful SBT rates were increased with PS, ATC, and PS/ATC SBTs compared to continuous positive airway pressure (CPAP) SBTs. Successful extubation rates were increased with PS [RR 1.06, (1.03-1.09); high certainty], ATC [RR 1.13, (1.05-1.21); moderate certainty], and HFNC [RR 1.06, (1.02-1.11); high certainty] SBTs, compared to T-piece SBTs. There was little to no difference in reintubation rates with PS (vs. T-piece) SBTs [RR 1.05, (0.91-1.21); low certainty], but increased reintubation rates with PS [RR 2.84, (1.61-5.03); moderate certainty] and ATC [RR 2.95 (1.57-5.56); moderate certainty] SBTs compared to HFNC SBTs.

CONCLUSIONS:

SBTs conducted with pressure augmentation (PS, ATC, PS/ATC) versus without (T-piece, CPAP) increased initial successful SBT and successful extubation rates. Although SBTs conducted with PS or ATC versus HFNC increased reintubation rates, this was not the case for PS versus T-piece SBTs.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ensayos Clínicos Controlados Aleatorios como Asunto / Metaanálisis en Red Límite: Humans Idioma: En Revista: Crit Care Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ensayos Clínicos Controlados Aleatorios como Asunto / Metaanálisis en Red Límite: Humans Idioma: En Revista: Crit Care Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido