Methods of Weaning From Mechanical Ventilation in Adult: A Network Meta-Analysis
Background/Objective: The aim of study is to assess the efficacy of each ventilator weaning method for ventilated patients in intensive care units (ICUs).Methods: A systematic search was conducted using PubMed, Embase, and China National Knowledge Infrastructure to identify randomized control studie...
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doaj-e88a195bab034d21aa05be1cbdd580f92021-10-04T05:39:34ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-10-01810.3389/fmed.2021.752984752984Methods of Weaning From Mechanical Ventilation in Adult: A Network Meta-AnalysisHong-Jie Jhou0Hong-Jie Jhou1Po-Huang Chen2Po-Huang Chen3Liang-Jun Ou-Yang4Chin Lin5Chin Lin6Shih-En Tang7Shih-En Tang8Cho-Hao Lee9Department of Neurology, Changhua Christian Hospital, Changhua, TaiwanSchool of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of General Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, TaiwanDepartment of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, TaiwanDepartment of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, TaiwanSchool of Public Health, National Defense Medical Center, Taipei, TaiwanDepartment of Research and Development, National Defense Medical Center, Taipei, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, TaiwanNational Defense Medical Center, Graduate Institute of Aerospace and Undersea Medicine, Taipei, Taiwan0Division of Hematology and Oncology Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, TaiwanBackground/Objective: The aim of study is to assess the efficacy of each ventilator weaning method for ventilated patients in intensive care units (ICUs).Methods: A systematic search was conducted using PubMed, Embase, and China National Knowledge Infrastructure to identify randomized control studies on ventilated patients regarding extubation associated outcomes (weaning success or failure, proportion requiring re-intubation, or mortality) from inception until April 01, 2020. Commonly used ventilation modes involved pressure support ventilation, synchronized intermittent mandatory ventilation, automatic tube compensation, continuous positive airway pressure, adaptive support ventilation, neurally adjusted ventilatory assist, proportional assisted ventilation, and SmartCare. Pooled estimates regarding extubation associated outcomes were calculated using network meta-analysis.Results: Thirty-nine randomized controlled trials including 5,953 patients met inclusion criteria. SmartCare and proportional assist ventilation were found to be effective methods in increasing weaning success (odds ratio, 2.72, 95% confidence interval (CI), 1.33–5.58, P-score: 0.84; odds ratio, 2.56, 95% CI, 1.60–4.11, P-score: 0.83; respectively). Besides, proportional assist ventilation had superior in reducing proportion requiring re-intubation rate (odds ratio, 0.48, 95% CI, 0.25–0.92, P-score: 0.89) and mortality (odds ratio, 0.48, 95% CI, 0.26–0.92, P-score: 0.91) than others.Conclusion: In general consideration, our study provided evidence that weaning with proportional assist ventilation has a high probability of being the most effective ventilation mode for patients with mechanical ventilation regarding a higher rate of weaning success, a lower proportion requiring reintubation, and a lower mortality rate than other ventilation modes.https://www.frontiersin.org/articles/10.3389/fmed.2021.752984/fullsystemic reviewnetwork meta-analysisweaningT-pieceproportional assist ventilationSmartCare |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hong-Jie Jhou Hong-Jie Jhou Po-Huang Chen Po-Huang Chen Liang-Jun Ou-Yang Chin Lin Chin Lin Shih-En Tang Shih-En Tang Cho-Hao Lee |
spellingShingle |
Hong-Jie Jhou Hong-Jie Jhou Po-Huang Chen Po-Huang Chen Liang-Jun Ou-Yang Chin Lin Chin Lin Shih-En Tang Shih-En Tang Cho-Hao Lee Methods of Weaning From Mechanical Ventilation in Adult: A Network Meta-Analysis Frontiers in Medicine systemic review network meta-analysis weaning T-piece proportional assist ventilation SmartCare |
author_facet |
Hong-Jie Jhou Hong-Jie Jhou Po-Huang Chen Po-Huang Chen Liang-Jun Ou-Yang Chin Lin Chin Lin Shih-En Tang Shih-En Tang Cho-Hao Lee |
author_sort |
Hong-Jie Jhou |
title |
Methods of Weaning From Mechanical Ventilation in Adult: A Network Meta-Analysis |
title_short |
Methods of Weaning From Mechanical Ventilation in Adult: A Network Meta-Analysis |
title_full |
Methods of Weaning From Mechanical Ventilation in Adult: A Network Meta-Analysis |
title_fullStr |
Methods of Weaning From Mechanical Ventilation in Adult: A Network Meta-Analysis |
title_full_unstemmed |
Methods of Weaning From Mechanical Ventilation in Adult: A Network Meta-Analysis |
title_sort |
methods of weaning from mechanical ventilation in adult: a network meta-analysis |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2021-10-01 |
description |
Background/Objective: The aim of study is to assess the efficacy of each ventilator weaning method for ventilated patients in intensive care units (ICUs).Methods: A systematic search was conducted using PubMed, Embase, and China National Knowledge Infrastructure to identify randomized control studies on ventilated patients regarding extubation associated outcomes (weaning success or failure, proportion requiring re-intubation, or mortality) from inception until April 01, 2020. Commonly used ventilation modes involved pressure support ventilation, synchronized intermittent mandatory ventilation, automatic tube compensation, continuous positive airway pressure, adaptive support ventilation, neurally adjusted ventilatory assist, proportional assisted ventilation, and SmartCare. Pooled estimates regarding extubation associated outcomes were calculated using network meta-analysis.Results: Thirty-nine randomized controlled trials including 5,953 patients met inclusion criteria. SmartCare and proportional assist ventilation were found to be effective methods in increasing weaning success (odds ratio, 2.72, 95% confidence interval (CI), 1.33–5.58, P-score: 0.84; odds ratio, 2.56, 95% CI, 1.60–4.11, P-score: 0.83; respectively). Besides, proportional assist ventilation had superior in reducing proportion requiring re-intubation rate (odds ratio, 0.48, 95% CI, 0.25–0.92, P-score: 0.89) and mortality (odds ratio, 0.48, 95% CI, 0.26–0.92, P-score: 0.91) than others.Conclusion: In general consideration, our study provided evidence that weaning with proportional assist ventilation has a high probability of being the most effective ventilation mode for patients with mechanical ventilation regarding a higher rate of weaning success, a lower proportion requiring reintubation, and a lower mortality rate than other ventilation modes. |
topic |
systemic review network meta-analysis weaning T-piece proportional assist ventilation SmartCare |
url |
https://www.frontiersin.org/articles/10.3389/fmed.2021.752984/full |
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