scholarly journals Pressure Support Ventilation Versus T-Piece Ventilation in Weaning Adult Patients on Invasive Mechanical Ventilation: A Meta-Analysis

2020 ◽  
Author(s):  
A.R.M. Villafuerte ◽  
J. Poblete ◽  
J.A. Sahagun ◽  
G.P.L. Ambrocio ◽  
M. Alejandria
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Support Ventilation

scholarly journals Proportional assist ventilation versus pressure support ventilation for weaning from mechanical ventilation in adults: a meta-analysis and trial sequential analysis

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Liang-Jun Ou-Yang ◽  
Po-Huang Chen ◽  
Hong-Jie Jhou ◽  
Vincent Yi-Fong Su ◽  
Cho-Hao Lee
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support Ventilation ◽  
Sequential Analysis ◽  
Pressure Support ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Proportional Assist Ventilation ◽  
Support Ventilation ◽  
Mechanical Ventilation Duration ◽  
Significant Difference

Abstract Background Pressure support ventilation (PSV) is the prevalent weaning method. Proportional assist ventilation (PAV) is an assisted ventilation mode, which is recently being applied to wean the patients from mechanical ventilation. Whether PAV or PSV is superior for weaning remains unclear. Methods Eligible randomized controlled trials published before April 2020 were retrieved from databases. We calculated the risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs). Results Seven articles, involving 634 patients, met the selection criteria. Compared to PSV, PAV was associated with a significantly higher rate of weaning success (fixed-effect RR 1.16; 95% CI 1.07–1.26; I2 = 0.0%; trial sequential analysis-adjusted CI 1.03–1.30), and the trial sequential monitoring boundary for benefit was crossed. Compared to PSV, PAV was associated with a lower proportion of patients requiring reintubation (RR 0.49; 95% CI 0.28–0.87; I2 = 0%), a shorter ICU length of stay (MD − 1.58 (days), 95% CI − 2.68 to − 0.47; I2 = 0%), and a shorter mechanical ventilation duration (MD − 40.26 (hours); 95% CI − 66.67 to − 13.84; I2 = 0%). There was no significant difference between PAV and PSV with regard to mortality (RR 0.66; 95% CI 0.42–1.06; I2 = 0%) or weaning duration (MD − 0.01 (hours); 95% CI − 1.30–1.28; I2 = 0%). Conclusion The results of the meta-analysis suggest that PAV is superior to PSV in terms of weaning success, and the statistical power is confirmed using trial sequential analysis. Graphical abstract

scholarly journals Neurally Adjusted Ventilatory Assist versus Pressure Support Ventilation in Difficult Weaning

2020 ◽  
Vol 132 (6) ◽  
pp. 1482-1493 ◽  
Author(s):  
Ling Liu ◽  
Xiaoting Xu ◽  
Qin Sun ◽  
Yue Yu ◽  
Feiping Xia ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Invasive Mechanical Ventilation ◽  
Neurally Adjusted Ventilatory Assist ◽  
Support Ventilation ◽  
Difficult Weaning ◽  
Diaphragm Electrical Activity ◽  
Ventilatory Assist ◽  
Successful Weaning

Abstract Background Difficult weaning frequently develops in ventilated patients and is associated with poor outcome. In neurally adjusted ventilatory assist, the ventilator is controlled by diaphragm electrical activity, which has been shown to improve patient–ventilator interaction. The objective of this study was to compare neurally adjusted ventilatory assist and pressure support ventilation in patients difficult to wean from mechanical ventilation. Methods In this nonblinded randomized clinical trial, difficult-to-wean patients (n = 99) were randomly assigned to neurally adjusted ventilatory assist or pressure support ventilation mode. The primary outcome was the duration of weaning. Secondary outcomes included the proportion of successful weaning, patient–ventilator asynchrony, ventilator-free days, and mortality. Weaning duration was calculated as 28 days for patients under mechanical ventilation at day 28 or deceased before day 28 without successful weaning. Results Weaning duration in all patients was statistically significant shorter in the neurally adjusted ventilatory assist group (n = 47) compared with the pressure support ventilation group (n = 52; 3.0 [1.2 to 8.0] days vs. 7.4 [2.0 to 28.0], mean difference: −5.5 [95% CI, −9.2 to −1.4], P = 0.039). Post hoc sensitivity analysis also showed that the neurally adjusted ventilatory assist group had shorter weaning duration (hazard ratio, 0.58; 95% CI, 0.34 to 0.98). The proportion of patients with successful weaning from invasive mechanical ventilation was higher in neurally adjusted ventilatory assist (33 of 47 patients, 70%) compared with pressure support ventilation (25 of 52 patients, 48%; respiratory rate for neurally adjusted ventilatory assist: 1.46 [95% CI, 1.04 to 2.05], P = 0.026). The number of ventilator-free days at days 14 and 28 was statistically significantly higher in neurally adjusted ventilatory assist compared with pressure support ventilation. Neurally adjusted ventilatory assist improved patient ventilator interaction. Mortality and length of stay in the intensive care unit and in the hospital were similar among groups. Conclusions In patients difficult to wean, neurally adjusted ventilatory assist decreased the duration of weaning and increased ventilator-free days. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals T-piece versus pressure-support ventilation for spontaneous breathing trials before extubation in patients at high risk of reintubation: protocol for a multicentre, randomised controlled trial (TIP-EX)

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e042619
Author(s):  
Arnaud W Thille ◽  
Rémi Coudroy ◽  
Arnaud Gacouin ◽  
Stephan Ehrmann ◽  
Damien Contou ◽  
...  
Keyword(s):  
High Risk ◽  
Randomised Controlled Trial ◽  
Pressure Support Ventilation ◽  
Spontaneous Breathing ◽  
Pressure Support ◽  
Controlled Trial ◽  
Invasive Mechanical Ventilation ◽  
Support Ventilation ◽  
Number Of Patients ◽  
Randomised Controlled

IntroductionIn intensive care unit (ICU), the decision of extubation is a critical time because mortality is particularly high in case of reintubation. To reduce that risk, guidelines recommend to systematically perform a spontaneous breathing trial (SBT) before extubation in order to mimic the postextubation physiological conditions. SBT is usually performed with a T-piece disconnecting the patient from the ventilator or with low levels of pressure-support ventilation (PSV). However, work of breathing is lower during PSV than during T-piece. Consequently, while PSV trial may hasten extubation, it may also increase the risk of reintubation. We hypothesise that, compared with T-piece, SBT performed using PSV may hasten extubation without increasing the risk of reintubation.Methods and analysisThis study is an investigator-initiated, multicentre randomised controlled trial comparing T-piece vs PSV for SBTs in patients at high risk of reintubation in ICUs. Nine hundred patients will be randomised with a 1:1 ratio in two groups according to the type of SBT. The primary outcome is the number of ventilator-free days at day 28, defined as the number of days alive and without invasive mechanical ventilation between the initial SBT (day 1) and day 28. Secondary outcomes include the number of days between the initial SBT and the first extubation attempt, weaning difficulty, the number of patients extubated after the initial SBT and not reintubated within the following 72 hours, the number of patients extubated within the 7 days following the initial SBT, the number of patients reintubated within the 7 days following extubation, in-ICU length of stay and mortality in ICU, at day 28 and at day 90.Ethics and disseminationThe study has been approved by the central ethics committee ‘Ile de France V’ (2019-A02151-56) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT04227639.

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