Association Between Spontaneous Breathing Trial Methods and Reintubation in Adult Critically Ill Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Chest Pub Date : 2024-11-01 Epub Date: 2024-07-02 DOI:10.1016/j.chest.2024.06.3773
Mariachiara Ippolito, Salvatore Sardo, Vincenzo Francesco Tripodi, Nicola Latronico, Elena Bignami, Antonino Giarratano, Andrea Cortegiani
{"title":"Association Between Spontaneous Breathing Trial Methods and Reintubation in Adult Critically Ill Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Mariachiara Ippolito, Salvatore Sardo, Vincenzo Francesco Tripodi, Nicola Latronico, Elena Bignami, Antonino Giarratano, Andrea Cortegiani","doi":"10.1016/j.chest.2024.06.3773","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Reintubation 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.</p><p><strong>Research question: </strong>Are different methods of conducting SBTs in critically ill patients associated with different risk of reintubation compared with T-tube?</p><p><strong>Study design and methods: </strong>We 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.</p><p><strong>Results: </strong>A 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).</p><p><strong>Interpretation: </strong>In 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.</p><p><strong>Trial registration: </strong>PROSPERO; No.: CRD42023449264; URL: https://www.crd.york.ac.uk/prospero/.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chest","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.chest.2024.06.3773","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/2 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Reintubation 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 question: Are different methods of conducting SBTs in critically ill patients associated with different risk of reintubation compared with T-tube?

Study design and methods: We 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.

Results: A 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).

Interpretation: In 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 registration: PROSPERO; No.: CRD42023449264; URL: https://www.crd.york.ac.uk/prospero/.

成人重症患者自主呼吸试验方法与再次插管之间的关系:随机对照试验的系统回顾和网络荟萃分析。
背景:再次插管与较高的死亡风险相关。目前尚无明确证据表明哪种自主呼吸试验(SBT)方法最能降低再次插管的风险:研究问题:与 T 型管相比,在重症患者中进行 SBT 的不同方法是否与不同的再插管风险相关?我们对调查不同 SBT 方法对再插管影响的随机对照试验 (RCT) 进行了系统综述和贝叶斯网络荟萃分析。我们调查了 PubMed、MEDLINE、CINAHL 和 CENTRAL 数据库从开始到 2024 年 1 月 26 日的数据。累积排名曲线下表面(SUCRA)用于确定干预措施被评为最佳的可能性。还通过频数荟萃分析对配对比较进行了研究。根据 GRADE 方法对证据的确定性进行了评估:结果:共纳入了 22 项研究性临床试验,共计 6196 名患者。该网络包括 9 个节点,有 13 项直接配对比较。约 71% 的患者被分配给 T 型管和 PSV-ZEEP,分别有 2135 名和 2101 名患者。与 T 型管相比,唯一能明显降低再次插管风险的干预措施是高流量供氧(HFO)(RR 0.23,CrI 0.09 至 0.51,中等质量证据)。高流量供氧是降低再插管风险的最佳干预措施的可能性最高(81.86%,SUCRA 96.42),其次是持续气道正压(11.8%,SUCRA 76.75):与其他 SBT 方法相比,HFO SBT 的再插管风险较低。由于研究 HFO SBT 的研究数量较少,以及与联合干预相关的潜在临床异质性,我们的分析结果应谨慎考虑。应进行更多的试验,以便在更大的患者群体中确认结果,并对特定的亚组进行评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信