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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

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

Authors: Karen E. A. Burns, Ibrahim Soliman, Neill K. J. Adhikari, Amer Zwein, Jessica T. Y. Wong, Carolina Gomez-Builes, Jose Augusto Pellegrini, Lu Chen, Nuttapol Rittayamai, Michael Sklar, Laurent J. Brochard, Jan O. Friedrich

Published in: Critical Care | Issue 1/2017

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Abstract

Background

The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain.

Methods

We 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.

Results

We 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.

Conclusions

Patients 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.
Appendix
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Metadata
Title
Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis
Authors
Karen E. A. Burns
Ibrahim Soliman
Neill K. J. Adhikari
Amer Zwein
Jessica T. Y. Wong
Carolina Gomez-Builes
Jose Augusto Pellegrini
Lu Chen
Nuttapol Rittayamai
Michael Sklar
Laurent J. Brochard
Jan O. Friedrich
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1698-x

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