Trial reportJAMA2013
Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation: a randomized trial.
Trial report in JAMA, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 65 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Weaning From Prolonged Mechanical Ventilation
Comparison of Two Strategies to Allow Mechanical Ventilation Separation Using Biphasic Airway Pressure Ventilation Without Any Synchronization (BIPAP) or Pressure Support Ventilation (PSV): a Randomized Feasibility Trial
Who cites it
65 citing papers in PubMed, 5 syntheses or guidelines pooled it, 192 citations in OpenAlex.
- Physiological Effects of High-Flow Tracheal Oxygen in Tracheostomized Patients Weaning From Mechanical Ventilation.Respiratory care · 2024Pooled it
- AARC Clinical Practice Guideline: Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation.Respiratory care · 2024Guideline
- Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis.Critical care (London, England) · 2017Pooled it
- Brazilian recommendations of mechanical ventilation 2013. Part 2.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia · 2014Guideline
- Pressure support versus T-tube for weaning from mechanical ventilation in adults.The Cochrane database of systematic reviews · 2014Pooled it
- Randomized clinical trial of ventilator liberation with pressure support ventilation versus therapist-implement patient-specific weaning in prolonged weaning patients via tracheostomy.BMC pulmonary medicine · 2026Trial
- Trial
- Effectiveness of a standardized weaning protocol in tracheostomized patients with prolonged mechanical ventilation: a prospective single-arm interventional trial.Journal of intensive care · 2026Article
- Liberation from Mechanical Ventilation in Acute Hypoxemic Respiratory Failure or Adult Respiratory Distress Syndrome: A Review.Journal of clinical medicine · 2026Review
- Expert consensus-based clinical practice guidelines for Care and weaning procedures in tracheostomized ICU patients after invasive mechanical ventilation: a joint statement by the Intensive Care Physiotherapy Society (SKR) and the French Intensive Care Society (SRLF).Annals of intensive care · 2026Article
- Determinants of time to decannulation and predictors of early weaning from tracheostomy: a multicenter, retrospective Italian cohort study.Annals of intensive care · 2026Article
- Gradual step-up weaning improves liberation in chronically ventilated tracheostomized patients.Critical care science · 2026Article
- Indicators of different outcomes after prolonged weaning.Scientific reports · 2025Article
- Influence of age on outcomes in prolonged weaning from mechanical ventilation.BMJ open respiratory research · 2025Article
- Air Hunger Far Exceeds Dyspnea Sense of Effort during Mechanical Ventilation and a Weaning Trial.American journal of respiratory and critical care medicine · 2025Article
- Prolonged T-Piece Spontaneous Breathing Trial and Extubation Outcomes in Patients Received Prolonged Mechanical Ventilation.Medicina (Kaunas, Lithuania) · 2025Article
- The 30-min diaphragm movement change rate for predicting weaning success in severe pneumonia patients requiring invasive ventilation.Frontiers in medicine · 2025Article
- Author Response: Let It Breathe: Mastering Spontaneous Breathing Trials.Respiratory care · 2024Article
- Differences between women and men in prolonged weaning.Respiratory research · 2024Article
- Reducing Airway Occlusion Time Without Losing Accuracy to Predict Successful Mechanical Ventilator Liberation During the Measurement of the Timed Inspiratory Effort Index.Respiratory care · 2024Observational
5 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
7 authors at 6 institutions in 1 country.
Funding
Abstract
importancePatients requiring prolonged mechanical ventilation (>21 days) are commonly weaned at long-term acute care hospitals (LTACHs). The most effective method of weaning such patients has not been investigated.
objectiveTo compare weaning duration with pressure support vs unassisted breathing through a tracheostomy collar in patients transferred to an LTACH for weaning from prolonged ventilation. DESIGN, SETTING, AND
participantsBetween 2000 and 2010, a randomized study was conducted in tracheotomized patients transferred to a single LTACH for weaning from prolonged ventilation. Of 500 patients who underwent a 5-day screening procedure, 316 did not tolerate the procedure and were randomly assigned to receive weaning with pressure support (n = 155) or a tracheostomy collar (n = 161). Survival at 6- and 12-month time points was also determined.
main outcome measurePrimary outcome was weaning duration. Secondary outcome was survival at 6 and 12 months after enrollment.
resultsOf 316 patients, 4 were withdrawn and not included in analysis. Of 152 patients in the pressure-support group, 68 (44.7%) were weaned; 22 (14.5%) died. Of 160 patients in the tracheostomy collar group, 85 (53.1%) were weaned; 16 (10.0%) died. Median weaning time was shorter with tracheostomy collar use (15 days; interquartile range [IQR], 8-25) than with pressure support (19 days; IQR, 12-31), P = .004. The hazard ratio (HR) for successful weaning rate was higher with tracheostomy collar use than with pressure support (HR, 1.43; 95% CI, 1.03-1.98; P = .033) after adjusting for baseline clinical covariates. Use of the tracheostomy collar achieved faster weaning than did pressure support among patients who did not tolerate the screening procedure between 12 and 120 hours (HR, 3.33; 95% CI, 1.44-7.70; P = .005), whereas weaning time was equivalent with the 2 methods in patients who did not tolerate the screening procedure within 0 to 12 hours. Mortality was equivalent in the pressure-support and tracheostomy collar groups at 6 months (55.92% vs 51.25%; 4.67% difference, 95% CI, -6.4% to 15.7%) and at 12 months (66.45% vs 60.00%; 6.45% difference, 95% CI, -4.2% to 17.1%). CONCLUSION AND RELEVANCE: Among patients requiring prolonged mechanical ventilation and treated at a single long-term care facility, unassisted breathing through a tracheostomy, compared with pressure support, resulted in shorter median weaning time, although weaning mode had no effect on survival at 6 and 12 months.
trial registrationclinicaltrials.gov Identifier: NCT01541462.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.