Background 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]). Methods 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). Results 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 2 = 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 2 = 5%), ICU mortality (odds ratio [OR] = 1.22; 95% CI, 0.83–1.80; P = 0.30; I 2 = 0%), hospital mortality (odds ratio [OR] = 1.36; 95% CI, 0.99–1.87; P = 0.06; I 2 = 19%), ICU length of stay (mean difference = − 0.10; 95% CI, − 0.59 to 0.39; P = 0.69; I 2 = 13%), and hospital length of stay (mean difference = − 0.82;95% CI, − 2.2 to 0.55; P = 0.24; I 2 = 0%). Conclusions 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.

中文翻译：

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T 型管和压力支持通气作为危重患者自主呼吸试验的比较：系统评价和荟萃分析

背景 替代性自主呼吸试验 (SBT) 技术对拔管成功和其他临床重要结果的影响尚不确定。进行了系统评价和荟萃分析，以阐明更可取的 SBT（T 形件或压力支持通气 [PSV]）。方法 我们在 PubMed、Cochrane 和 Embase 数据库中搜索了从开始到 2019 年 7 月 31 日的随机对照试验 (RCT)。我们纳入了涉及至少接受过两种不同 SBT 方法的成年患者（> 18 岁）的 RCT。所有作者都报告了拔管成功率的主要结果，并明确比较了 PS 与 T 型管与临床相关次要结果（再插管率、ICU 和住院时间以及 ICU 和住院死亡率）。结果表示为优势比 (OR) 和平均差 (MD) 以及伴随的 95% 置信区间 (CI)。结果共纳入10项RCTs，共3165例患者。这项荟萃分析的结果表明，T 形件组和 PS 组之间的成功拔管率没有显着差异（优势比 [OR] = 0.91；95% CI，0.78-1.07；P = 0.27；I 2 = 79%）。此外，与PS组相比，T形件组的再插管率无显着差异（优势比[OR] = 0.99；95% CI，0.78-1.26；P = 0.95；I 2 = 5%） , ICU 死亡率（优势比 [OR] = 1.22；95% CI，0.83–1.80；P = 0.30；I 2 = 0%），住院死亡率（优势比 [OR] = 1.36；95% CI，0.99–1.87； P = 0.06；I 2 = 19%），ICU 住院时间（平均差 = − 0.10；95% CI，− 0.59 至 0.39；P = 0.69；I 2 = 13%），和住院时间（平均差异 = − 0.82；95% CI，− 2.2 至 0.55；P = 0.24；I 2 = 0%）。结论 T 型管和 PSV 作为 SBT 被认为对危重患者成功拔管具有相当的预测能力。次要结局的分析也显示，两组的再插管率、ICU 和住院时间以及 ICU 和住院死亡率没有显着差异。仍然需要对 SBT 进行进一步的随机对照研究。以及两组间ICU病死率和住院病死率。仍然需要对 SBT 进行进一步的随机对照研究。以及两组间ICU病死率和住院病死率。仍然需要对 SBT 进行进一步的随机对照研究。