Respiratory failure & ventilation
Comparative effectiveness of alternative spontaneous breathing trial techniques: a systematic review and network meta-analysis of randomized trials
Authors' conclusion
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.
Study context
- Population
- Critically ill adults and children undergoing spontaneous breathing trial (SBT)
- Participants
- 6,716 adults · 40 RCTs
- Comparison
- Alternative SBT techniques
- Outcome
- Initial SBT success, successful extubation, reintubation
Methodological detailsfrequentist random-effects network meta-analysis, randomised or quasi-randomised trials, Medline, EMBASE, Cochrane Central searched from inception to February 2023
- Frequentist random-effects network meta-analysis
- Randomised or quasi-randomised trials
- Medline, EMBASE, Cochrane Central searched from inception to February 2023
Pooled result
As reported in the abstract
Initial successful SBT
Each group vs T-pieceRR for initial SBT success (95% CI)
PSmoderate certainty
1.08(1.05–1.11)
PS/ATCmoderate certainty
1.12(1.01–1.25)
HFNCmoderate certainty
1.07(1.00–1.13)
ATClow certainty
1.11(1.03–1.20)
Further pooled results
| Outcome | Estimate | |
|---|---|---|
| Successful extubation (primary outcome)PS vs T-piece · high certainty | RR for successful extubation 1.06 (CI 1.03–1.09) | |
| Successful extubation (primary outcome)ATC vs T-piece · moderate certainty | RR for successful extubation 1.13 (CI 1.05–1.21) | |
| Successful extubation (primary outcome)HFNC vs T-piece · high certainty | RR for successful extubation 1.06 (CI 1.02–1.11) | |
| Reintubation (primary outcome)PS vs T-piece · low certainty; little to no difference | RR for reintubation 1.05 (CI 0.91–1.21) | |
| Reintubation (primary outcome)PS vs HFNC · moderate certainty | RR for reintubation 2.84 (CI 1.61–5.03) | |
| Reintubation (primary outcome)ATC vs HFNC · moderate certainty | RR for reintubation 2.95 (CI 1.57–5.56) | |
| 0.20.5125Ratio (log scale) |
Safety
| Outcome | RR (CI) | |
|---|---|---|
| Reintubation (primary outcome)PS vs T-piece · low certainty; little to no difference | 1.05 (0.91–1.21) | |
| Reintubation (primary outcome)PS vs HFNC · moderate certainty | 2.84 (1.61–5.03) | |
| Reintubation (primary outcome)ATC vs HFNC · moderate certainty | 2.95 (1.57–5.56) | |
| 0.20.5125Relative risk (log scale) |
Original publication
Comparative effectiveness of alternative spontaneous breathing trial techniques: a systematic review and network meta-analysis of randomized trials. Crit Care. Published 8 June 2024. doi:10.
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