Pressure Support vs. T-Piece SBT for Successful Extubation
Trial question
What is the effect of spontaneous breathing trial of pressure support ventilation strategy among patients receiving mechanical ventilation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 1153
1153 patients (428 female, 725 male).
Inclusion criteria: adult patients deemed ready for weaning after at least 24 hours of mechanical ventilation.
Key exclusion criteria: tracheostomies or do-not-reintubate orders.
Interventions
N=575 pressure support ventilation strategy (a 30-minute spontaneous breathing trial with 8 cmH₂O pressure support ventilation).
N=578 T-piece ventilation strategy (2 hours of T-piece spontaneous breathing trial).
Primary outcome
Successful extubation
82.3%
74%
82.3 %
61.7 %
41.1 %
20.6 %
0.0 %
Pressure support ventilation
strategy
T-piece ventilation
strategy
Significant
increase ▲
NNT = 12
Significant increase in successful extubation (82.3% vs. 74%; AD 8.2%, 95% CI 3.4 to 13).
Secondary outcomes
No significant difference in reintubation (11.1% vs. 11.9%; ARD -0.8, 95% CI -4.8 to 3.1).
No significant difference in ICU length of stay (9 days vs. 10 days; AD -0.3 days, 95% CI -1.7 to 1.1).
Significant decrease in death at 90 days (13.2% vs. 17.3%; HR 0.74, 95% CI 0.55 to 0.99).
Safety outcomes
No significant differences in hemodynamic shock, agitation, airway obstruction, difficulty managing secretions.
Significant differences in death in the hospital (10.4% vs. 14.9%), aspiration (1.7% vs. 5.2%), cardiac arrest (1.7% vs. 5.1%).
Conclusion
In adult patients deemed ready for weaning after at least 24 hours of mechanical ventilation, pressure support ventilation strategy was superior to T-piece ventilation strategy with respect to successful extubation.
Reference
Carles Subirà, Gonzalo Hernández, Antònia Vázquez et al. Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA. 2019 Jun 11;321(22):2175-2182.
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