scholarly journals Methods of Weaning From Mechanical Ventilation in Adult: A Network Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Hong-Jie Jhou ◽  
Po-Huang Chen ◽  
Liang-Jun Ou-Yang ◽  
Chin Lin ◽  
Shih-En Tang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Ventilator Weaning ◽  
Neurally Adjusted Ventilatory Assist ◽  
Proportional Assist Ventilation ◽  
China National Knowledge Infrastructure ◽  
Support Ventilation ◽  
Ventilation Modes ◽  
Ventilated Patients

Background/Objective: The aim of study is to assess the efficacy of each ventilator weaning method for ventilated patients in intensive care units (ICUs).Methods: A systematic search was conducted using PubMed, Embase, and China National Knowledge Infrastructure to identify randomized control studies on ventilated patients regarding extubation associated outcomes (weaning success or failure, proportion requiring re-intubation, or mortality) from inception until April 01, 2020. Commonly used ventilation modes involved pressure support ventilation, synchronized intermittent mandatory ventilation, automatic tube compensation, continuous positive airway pressure, adaptive support ventilation, neurally adjusted ventilatory assist, proportional assisted ventilation, and SmartCare. Pooled estimates regarding extubation associated outcomes were calculated using network meta-analysis.Results: Thirty-nine randomized controlled trials including 5,953 patients met inclusion criteria. SmartCare and proportional assist ventilation were found to be effective methods in increasing weaning success (odds ratio, 2.72, 95% confidence interval (CI), 1.33–5.58, P-score: 0.84; odds ratio, 2.56, 95% CI, 1.60–4.11, P-score: 0.83; respectively). Besides, proportional assist ventilation had superior in reducing proportion requiring re-intubation rate (odds ratio, 0.48, 95% CI, 0.25–0.92, P-score: 0.89) and mortality (odds ratio, 0.48, 95% CI, 0.26–0.92, P-score: 0.91) than others.Conclusion: In general consideration, our study provided evidence that weaning with proportional assist ventilation has a high probability of being the most effective ventilation mode for patients with mechanical ventilation regarding a higher rate of weaning success, a lower proportion requiring reintubation, and a lower mortality rate than other ventilation modes.

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 as a weaning mode for adults with invasive mechanical ventilation: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Xueyan Yuan ◽  
Xinxing Lu ◽  
Yali Chao ◽  
Jennifer Beck ◽  
Christer Sinderby ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Practice ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Cochrane Library ◽  
Neurally Adjusted Ventilatory Assist ◽  
Partial Support ◽  
Ventilatory Assist

Abstract Background Prolonged ventilatory support is associated with poor clinical outcomes. Partial support modes, especially pressure support ventilation, are frequently used in clinical practice but are associated with patient–ventilation asynchrony and deliver fixed levels of assist. Neurally adjusted ventilatory assist (NAVA), a mode of partial ventilatory assist that reduces patient–ventilator asynchrony, may be an alternative for weaning. However, the effects of NAVA on weaning outcomes in clinical practice are unclear. Methods We searched PubMed, Embase, Medline, and Cochrane Library from 2007 to December 2020. Randomized controlled trials and crossover trials that compared NAVA and other modes were identified in this study. The primary outcome was weaning success which was defined as the absence of ventilatory support for more than 48 h. Summary estimates of effect using odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with accompanying 95% confidence interval (CI) were expressed. Results Seven studies (n = 693 patients) were included. Regarding the primary outcome, patients weaned with NAVA had a higher success rate compared with other partial support modes (OR = 1.93; 95% CI 1.12 to 3.32; P = 0.02). For the secondary outcomes, NAVA may reduce duration of mechanical ventilation (MD = − 2.63; 95% CI − 4.22 to − 1.03; P = 0.001) and hospital mortality (OR = 0.58; 95% CI 0.40 to 0.84; P = 0.004) and prolongs ventilator-free days (MD = 3.48; 95% CI 0.97 to 6.00; P = 0.007) when compared with other modes. Conclusions Our study suggests that the NAVA mode may improve the rate of weaning success compared with other partial support modes for difficult to wean patients.

Mechanical Ventilation Modes

2017 ◽  
Author(s):  
Yuan Lei
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Ventilation Mode ◽  
Support Ventilation ◽  
Ventilation Modes ◽  
Standardized Terminology ◽  
Signature Waveforms ◽  
Shed Light

‘Mechanical Ventilation Modes’ seeks to shed light on this hotly debated topic, one that is complicated by ventilator manufacturers’ non-standardized terminology. The chapter looks at conventional modes, adaptive modes, and biphasic modes, which it classifies based on the mechanical breath types in each mode. It includes a comparison chart of the terminology used for common modes on popular IPPV ventilators. Using their signature waveforms, the author describes the assist/control, SIMV, and pressure support ventilation or PSV modes. It defines the modes by their application of spontaneous breaths and mandatory breaths. It continues with a discussion of adaptive modes and biphasic modes. It ends by discussing how to select the appropriate ventilation mode.

Association between FSAP 1601G>A polymorphism and venous thromboembolism risk: A meta-analysis

2019 ◽  
Vol 35 (5) ◽  
pp. 345-353
Author(s):  
Li Da ◽  
Zhao Jiahui ◽  
Li Xiaoqiang
Keyword(s):  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Web Of Science ◽  
Meta Analysis ◽  
Factor Vii ◽  
Case Control Studies ◽  
China National Knowledge Infrastructure ◽  
Bias Assessment ◽  
Knowledge Infrastructure

Objective Previous several studies have shown that factor VII-activating protease (FSAP) gene 1601G>A polymorphism is related to the occurrence of venous thromboembolism, but the results are inconsistent and controversial. Therefore, we conducted a meta-analysis to explore the association between FSAP 1601G>A polymorphism and venous thromboembolism susceptibility. Methods We managed a systematic literature search through Pubmed, Embase, Web of Science, China National Knowledge Infrastructure, and WanFang databases to collect research data related to FSAP gene 1601G>A polymorphism and susceptibility to venous thromboembolism published before May 2019. Data analysis was performed through Revman 5.3 and Stata 12.0 software, the pooled odd ratios and 95% confidence intervals were calculated. Additionally, the sensitivity analysis and publication bias assessment were also performed. Results A total of seven case–control studies were included and evaluated, including 2411 venous thromboembolism cases and 2850 controls. The meta-analysis results revealed that the FSAP 1601G>A mutation is associated with venous thromboembolism risk, and statistically significance was observed under three genetic comparison models (A: G, odds ratio: 1.33, 95% confidence interval: 1.07–1.66; GA: GG, odds ratio: 1.34, 95% confidence interval: 1.06–1.68; and GA + AA: GG, odds ratio: 1.33, 95% confidence interval: 1.06–1.66). Conclusion This study demonstrated that the FSAP 1601G>A polymorphism may be associated with venous thromboembolism susceptibility.

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