• Mariachiara Ippolito, Salvatore Sardo, Vincenzo Francesco Tripodi, Nicola Latronico, Elena Bignami, Antonino Giarratano, and Andrea Cortegiani.
• SIAARTI Systematic Review Group, Rome, Italy; Department of Anesthesia, Analgesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy; Department of Precision Medicine in Medical, Surgical and Critical Care. University of Palermo, Palermo, Italy.
• Chest. 2024 Nov 1; 166 (5): 102010341020-1034.

BackgroundReintubation is associated with higher risk of mortality. There is no clear evidence on the best spontaneous breathing trial (SBT) method to reduce the risk of reintubation.Research QuestionAre different methods of conducting SBTs in critically ill patients associated with different risk of reintubation compared with T-tube?Study Design And MethodsWe conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials investigating the effects of different SBT methods on reintubation. We surveyed PubMed, MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to January 26, 2024. The surface under the cumulative ranking curve (SUCRA) was used to determine the likelihood that an intervention was ranked as the best. Pairwise comparisons were also investigated by frequentist meta-analysis. Certainty of the evidence was assessed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach.ResultsA total of 22 randomized controlled trials were included, for a total of 6,196 patients. The network included nine nodes, with 13 direct pairwise comparisons. About 71% of the patients were allocated to T-tube and pressure support ventilation without positive end-expiratory pressure, with 2,135 and 2,101 patients, respectively. The only intervention with a significantly lower risk of reintubation compared with T-tube was high-flow oxygen (HFO) (risk ratio, 0.23; 95% credibility interval, 0.09-0.51; moderate quality evidence). HFO was associated with the highest probability of being the best intervention for reducing the risk of reintubation (81.86%; SUCRA, 96.42), followed by CPAP (11.8%; SUCRA, 76.75).InterpretationIn this study, HFO SBT was associated with a lower risk of reintubation compared with other SBT methods. The results of our analysis should be considered with caution due to the low number of studies that investigated HFO SBTs and potential clinical heterogeneity related to cointerventions. Further trials should be performed to confirm the results on larger cohorts of patients and to assess specific subgroups.Trial RegistrationPROSPERO; No.: CRD42023449264; URL: https://www.crd.york.ac.uk/prospero/.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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