Evidence map›Paper›PMID 38849936›Full record

SynthesisCritical care (London, England)2024

Comparative effectiveness of alternative spontaneous breathing trial techniques: a systematic review and network meta-analysis of randomized trials.

Karen E A Burns, Behnam Sadeghirad, Maryam Ghadimi, Jeena Khan, Vorakamol Phoophiboon, Vatsal Trivedi, Carolina Gomez Builes, Benedetta Giammarioli, Kimberley Lewis, Dipayan Chaudhuri and 2 more

Registry-linked trialAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07005505 (Automatic Tube Compensation vs. Pressure Support Ventilation During Spontaneous Breathing Trials in Critically Ill Adults), which is not on this map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

NCT07005505 narecruitingnot on this mapstarted 2025, after this paper: background citation

Automatic Tube Compensation vs. Pressure Support Ventilation During Spontaneous Breathing Trials in Critically Ill Adults: A Cluster-Randomized, Cluster-Crossover Trial

TypeinterventionalSponsorRush University Medical CenterRan2025 to 2027Enrolled880ConditionsSpontaneous Breathing Trial in ICUArmsPressure Support Ventilation (PSV), Automatic tube compensation (ATC)
3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Trial
  2. Review
  3. Observational
  4. Article
  5. Article
  6. Article
  7. Observational
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Karen E A BurnsDepartments 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.
Behnam SadeghiradDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Maryam GhadimiDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Jeena KhanDepartments 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.
Vorakamol PhoophiboonDepartments 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.
Vatsal TrivediDepartment of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada.
Carolina Gomez BuilesDepartment of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada.
Benedetta GiammarioliDepartment of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada.
Kimberley LewisDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Dipayan ChaudhuriDepartments of Anesthesia and Medicine, McMaster University, Hamilton, Canada.
Kairavi DesaiMichael DeGroote School of Medicine, McMaster University, Hamilton, Canada.
Jan O FriedrichDepartments 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.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe 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.

methodsWe 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.

resultsWe 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.

conclusionsSBTs 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.

Indexed as

Randomized Controlled Trials as TopicAirway ExtubationHumansVentilator WeaningExtubationNetwork meta-analysisReintubationSpontaneous breathing trialWeaning

Identifiers

PMID38849936
PMCPMC11162018

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

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.