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.
OBJECTIVE: Are different methods of conducting SBTs in critically ill patients associated with different risk of reintubation compared with T-tube?
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 with 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).
CONCLUSIONS: HFO SBT was associated with a lower risk of reintubation in comparison 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 assess specific subgroups.
BACKGROUND: PROSPERO; No.: CRD42023449264; URL: https://www.crd.york.ac.uk/prospero/.
OBJECTIVE: Are different methods of conducting SBTs in critically ill patients associated with different risk of reintubation compared with T-tube?
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 with 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).
CONCLUSIONS: HFO SBT was associated with a lower risk of reintubation in comparison 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 assess specific subgroups.
BACKGROUND: PROSPERO; No.: CRD42023449264; URL: https://www.crd.york.ac.uk/prospero/.
摘要：
背景：重新插管与较高的死亡风险相关。没有明确的证据表明最好的自主呼吸试验（SBT）方法可以降低再插管的风险。
目的：与T管相比，在危重患者中进行SBT的不同方法是否具有不同的再插管风险？
方法：我们对随机对照试验（RCT）进行了系统评价和贝叶斯网络荟萃分析，研究了不同SBT方法对再插管的影响。我们调查了PubMed,MEDLINE,CINAHL和CENTRAL数据库从开始到2024年1月26日。累积排序曲线下的表面(SUCRA)用于确定干预被评为最佳的可能性。还通过频率荟萃分析研究了成对比较。根据等级方法评估证据的确定性。
结果：共纳入22项随机对照试验，共6196名患者。该网络包括9个节点，有13个直接成对比较。大约71％的患者被分配到T型管和PSV-ZEEP，2135和2101名患者，分别。与T管相比，唯一的再插管风险显着降低的干预措施是高流量氧气（HFO）（RR0.23，CrI0.09至0.51，中等质量证据）。HFO与降低再插管风险的最佳干预措施的可能性最高（81.86%，SUCRA96.42),其次是持续气道正压通气(11.8%，SUCRA76.75).
结论：与其他SBT方法相比，HFOSBT与更低的再插管风险相关。我们的分析结果应谨慎考虑，因为调查HFOSBT的研究数量较少，以及与共同干预相关的潜在临床异质性。应进行进一步的试验以确认更大的患者队列的结果并评估特定的亚组。
目的：与T管相比，在危重患者中进行SBT的不同方法是否具有不同的再插管风险？
方法：我们对随机对照试验（RCT）进行了系统评价和贝叶斯网络荟萃分析，研究了不同SBT方法对再插管的影响。我们调查了PubMed,MEDLINE,CINAHL和CENTRAL数据库从开始到2024年1月26日。累积排序曲线下的表面(SUCRA)用于确定干预被评为最佳的可能性。还通过频率荟萃分析研究了成对比较。根据等级方法评估证据的确定性。
结果：共纳入22项随机对照试验，共6196名患者。该网络包括9个节点，有13个直接成对比较。大约71％的患者被分配到T型管和PSV-ZEEP，2135和2101名患者，分别。与T管相比，唯一的再插管风险显着降低的干预措施是高流量氧气（HFO）（RR0.23，CrI0.09至0.51，中等质量证据）。HFO与降低再插管风险的最佳干预措施的可能性最高（81.86%，SUCRA96.42),其次是持续气道正压通气(11.8%，SUCRA76.75).
结论：与其他SBT方法相比，HFOSBT与更低的再插管风险相关。我们的分析结果应谨慎考虑，因为调查HFOSBT的研究数量较少，以及与共同干预相关的潜在临床异质性。应进行进一步的试验以确认更大的患者队列的结果并评估特定的亚组。
