• BurnsKaren E AKEASt Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.Department of Clini, Ibrahim Soliman, AdhikariNeill K JNKJInterdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada., Amer Zwein, Jessica T Y Wong, Carolina Gomez-Builes, Jose Augusto Pellegrini, Lu Chen, Nuttapol Rittayamai, Michael Sklar, Laurent J Brochard, and Jan O Friedrich.
• St Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
• Crit Care. 2017 Jun 1; 21 (1): 127127.

BackgroundThe effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain.MethodsWe searched MEDLINE, EMBASE, CENTRAL, CINAHL, Evidence-Based Medicine Reviews, Ovid Health Star, proceedings of five conferences (1990-2016), and reference lists for randomized trials comparing SBT techniques in intubated adults or children. Primary outcomes were initial SBT success, extubation success, or reintubation. Two reviewers independently screened citations, assessed trial quality, and abstracted data.ResultsWe identified 31 trials (n = 3541 patients). Moderate-quality evidence showed that patients undergoing pressure support (PS) compared with T-piece SBTs (nine trials, n = 1901) were as likely to pass an initial SBT (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.89-1.11; I 2 = 77%) but more likely to be ultimately extubated successfully (RR 1.06, 95% CI 1.02-1.10; 11 trials, n = 1904; I 2 = 0%). Exclusion of one trial with inconsistent results for SBT and extubation outcomes suggested that PS (vs T-piece) SBTs also improved initial SBT success (RR 1.06, 95% CI 1.01-1.12; I 2 = 0%). Limited data suggest that automatic tube compensation plus continuous positive airway pressure (CPAP) vs CPAP alone or PS increase SBT but not extubation success.ConclusionsPatients undergoing PS (vs T-piece) SBTs appear to be 6% (95% CI 2-10%) more likely to be extubated successfully and, if the results of an outlier trial are excluded, 6% (95% CI 1-12%) more likely to pass an SBT. Future trials should investigate patients for whom SBT and extubation outcomes are uncertain and compare techniques that maximize differences in support.

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