Li Yuting, Li Hongxiang, Zhang Dong
Department of Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin, 130021, China.
Crit Care. 2020 Feb 26;24(1):67. doi: 10.1186/s13054-020-2764-3.
The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. A systematic review and meta-analysis was performed to clarify the preferable SBT (T-piece or pressure support ventilation [PSV]).
We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) from inception to the 31st of July 2019. We included RCTs involving adult patients (> 18 years) who underwent at least two different SBT methods. All authors reported our primary outcome of successful extubation rate and clearly compared PS versus T-piece with clinically relevant secondary outcomes (rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).
Ten RCTs including 3165 patients were included. The results of this meta-analysis showed that there was no significant difference in the successful extubation rate between the T-piece group and PS group (odds ratio [OR] = 0.91; 95% CI, 0.78-1.07; P = 0.27; I = 79%). In addition, compared with the PS group, the T-piece group showed no significant difference in the rate of reintubation (odds ratio [OR] = 0.99; 95% CI, 0.78-1.26; P = 0.95; I = 5%), ICU mortality (odds ratio [OR] = 1.22; 95% CI, 0.83-1.80; P = 0.30; I = 0%), hospital mortality (odds ratio [OR] = 1.36; 95% CI, 0.99-1.87; P = 0.06; I = 19%), ICU length of stay (mean difference = - 0.10; 95% CI, - 0.59 to 0.39; P = 0.69; I = 13%), and hospital length of stay (mean difference = - 0.82;95% CI, - 2.2 to 0.55; P = 0.24; I = 0%).
T-piece and PSV as SBTs are considered to have comparable predictive power of successful extubation in critically ill patients. The analysis of secondary outcomes also shows no significant difference in the rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality between the two groups. Further randomized controlled studies of SBTs are still required.
不同的自主呼吸试验（SBT）技术对拔管成功率及其他临床重要结局的影响尚不确定。本研究进行了一项系统评价和荟萃分析，以明确更优的SBT方法（T管法或压力支持通气[PSV]）。
检索PubMed、Cochrane和Embase数据库，纳入自建库至2019年7月31日的随机对照试验（RCT）。纳入涉及成年患者（>18岁）且至少接受过两种不同SBT方法的RCT。所有作者均报告了我们的主要结局即拔管成功率，并对PSV与T管法在临床相关次要结局（再插管率、ICU和住院时间、ICU和医院死亡率）方面进行了明确比较。结果以比值比（OR）和平均差（MD）及95%置信区间（CI）表示。
纳入10项RCT，共3165例患者。该荟萃分析结果显示，T管法组与PSV组的拔管成功率无显著差异（比值比[OR]=0.91；95%CI，0.78 - 1.07；P = 0.27；I² = 79%）。此外，与PSV组相比，T管法组在再插管率（比值比[OR]=0.99；95%CI，0.78 - 1.26；P = 0.95；I² = 5%）、ICU死亡率（比值比[OR]=1.22；95%CI，0.83 - 1.80；P = 0.30；I² = 0%）、医院死亡率（比值比[OR]=1.36；95%CI，0.99 - 1.87；P = 0.06；I² = 19%）、ICU住院时间（平均差=-0.10；95%CI，-0.59至0.39；P = 0.69；I² = 13%）及医院住院时间（平均差=-0.82；95%CI，-2.2至0.55；P = 0.24；I² = 0%）方面均无显著差异。
T管法和PSV作为SBTs，在危重症患者中对成功拔管具有相当的预测能力。次要结局分析也显示，两组在再插管率、ICU和医院住院时间、ICU和医院死亡率方面无显著差异。仍需进一步开展SBTs的随机对照研究。
