Spontaneous Breathing Trials With T-Piece or Pressure Support Ventilation

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Evidence-Based Medicine

Background:

• Spontaneous breathing trials (SBTs) are crucial for weaning patients from mechanical ventilation.
• The optimal SBT method, T-piece versus pressure support ventilation (PSV), remains debated.
• Clarifying the preferred SBT technique can improve patient outcomes and resource utilization.

Purpose of the Study:

• To systematically review and compare the efficacy of T-piece versus PSV during SBTs for mechanical ventilation weaning.
• To assess the impact of SBT technique on weaning failure, re-intubation, ICU mortality, and weaning duration.
• To explore potential benefits in specific subgroups, including simple, difficult, prolonged weaning, and COPD patients.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials comparing T-piece and PSV for SBTs.
• Searched multiple databases (MEDLINE, EMBASE, etc.) through June 2015 without language restrictions.
• Included studies reporting weaning failure, re-intubation, ICU mortality, or weaning duration; analyzed subgroups using GRADE methodology.

Main Results:

• Twelve studies (2,161 subjects) met inclusion criteria; overall evidence quality was very low to low.
• No significant differences were found between T-piece and PSV for overall weaning success, ICU mortality, or re-intubation rates.
• PSV showed a potential benefit in weaning success for simple-to-wean subjects; T-piece was associated with shorter weaning duration in prolonged-weaning patients.

Conclusions:

• Low-quality evidence currently exists regarding the preferred SBT technique.
• PSV may reduce weaning failure in simple-to-wean patients.
• T-piece may shorten weaning duration in prolonged-weaning patients, but with high risk of bias; further research on difficult-to-wean and COPD subgroups is needed.