The small red lines at the top and bottom left-hand corners, trial sequential boundaries for benefit or harm, represent the threshold for statistical significance in TSA. 2009;62(10):e134. Google Scholar. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. 2019;321(22):217582. Therefore, TSA was conducted to challenge the meta-analysis, in case the data were too sparse to confirm the conclusions, and avoid early overestimates by combining the estimated required information size with an adjusted threshold [25]. Table S4. The horizontal dark red lines represent the threshold for significance in conventional meta-analysis, at 1.96 of the Z value, corresponding to 0.05 of the P value. However, patient-ventilator asynchrony is a burden for patients with PSV.

Summary individual-study characteristics and study-level patient characteristics from all included randomized trials are reported in Table1 and Additionalfile1: Table S3. Numerous recent studies have compared PAV to traditional PSV; however, data on this topic are still limited. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. These results were shown to be sufficient and conclusive using TSA. Res Synth Methods. The included studies evaluated 634 patients randomized to two interventions: 326 patients receiving PAV as the weaning method and 308 receiving PSV. The quality assessment using the GRADE approach was moderate (Additionalfile1: Table S4).

Sparse data and repetitive testing of accumulating data in meta-analyses can produce an increased risk of both type 1 and type 2 errors [23, 24]. S1. PAV generates pressure in proportion to the patients instantaneous breathing effort, providing timely adjustment, thereby improving the patient-ventilator relationship [6].

The extubation failure rate at 48 h did not differ significantly between the groups: 11/87 (13%) versus 4/21 (19%), P=0.39.

However, Kataoka et al. We also performed a sensitivity analysis, removing high risk of bias studies, and the results did not change substantially (Additionalfile1: Fig.

Five of these trials [4, 27, 28, 31, 32] included patients who were intubated due to a medical emergency, and two [29, 30] evaluated patients requiring mechanical ventilator support due to a medical or surgical cause. Eligible randomized controlled trials published before April 2020 were retrieved from databases. Pereira TV, Patsopoulos NA, Salanti G, Ioannidis JP. In one meta-analysis performed by Kataoka et al. Of the patients, 21/118 (18%) could be extubated after a trial with PS, despite having failed a T-tube trial. If this was successful, they were immediately extubated. Zein H, Baratloo A, Negida A, Safari S. Ventilator weaning and spontaneous breathing trials; an educational review. The site is secure. Our results also revealed a lower reintubation rate and a shorter ICU length of stay in patients undergoing PAV compared to patients undergoing PSV. Search strategy in MEDLINE (Ovid), Embase, and Cochrane Library.

Intensive Care Med. Anaesthesia.

Lau J, Ioannidis JPA, Terrin N, Schmid CH, Olkin I. Fig. The case of the misleading funnel plot. Sensitivity analyses of outcomes were conducted by excluding the trials with a high risk of bias. Measuring inconsistency in meta-analyses. This meta-analysis compared the efficacy of PAV and PSV as weaning methods in mechanically ventilated patients. We screened 379 article titles and abstracts from the electronic databases, excluded 342 articles, and retrieved 37 articles for full-text assessment.

Proportional assist ventilation versus pressure support ventilation for weaning from mechanical ventilation in adults: a meta-analysis and trial sequential analysis. Subgroup analysis of outcomes by the types of different proportional modes. icu healthmanagement ventilated mechanically obese Cleve Clin J Med. endotracheal tidal weaning eet oxygen inspiratory 2016;4(2):6571. 2022 Feb 7;23(1):22. doi: 10.1186/s12931-022-01942-w. Yi LJ, Tian X, Chen M, Lei JM, Xiao N, Jimnez-Herrera MF.

2010;1:3.

-, Chest. Botha J, Green C, Carney I, Haji K, Gupta S, Tiruvoipati R. Proportional assist ventilation versus pressure support ventilation in weaning ventilation: a pilot randomised controlled trial. . Therefore, TSA confirmed our meta-analysis providing convincing statistical evidence. Two independent investigators (PHC and LJOY) conducted a systematic search for RCTs published up until April 2020, using the terms Proportional Assisted Ventilation, Pressure Support Ventilation, Ventilation Weaning, and Spontaneous Breathing Trial (Additionalfile1: Table S2). The TSA results of all secondary outcomes demonstrated inconclusive results with sparse data, which are described in Additionalfile1: Fig. CAS Int J Epidemiol. Furthermore, the GRADE methodology was conducted to qualify the evidence of the results through critical appraisal of the included studies. Egypt J Chest Dis Tuberc. Spine (Phila Pa 1976). Shah A, Smith AF. Emerg (Tehran).

eCollection 2021. We used a mixed-effects linear meta-regression model [19] to evaluate the cause of heterogeneity for all outcomes, with variables including mean age, sex, MV baseline duration, and physiology score. 2018;8(1):123. Furthermore, mechanical ventilation is provided not only for respiratory reasons but also for unstable and comatose patients. We extracted data on one primary outcome and five secondary outcomes.

Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial. Crit Care Med. 2019;22(4):15360. 2008;61(1):6475. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, Thomas J. 2001;20(24):387589. Provided by the Springer Nature SharedIt content-sharing initiative. 2009;38(1):28798. Comparison of proportional assist ventilation plus, T-tube ventilation, and pressure support ventilation as spontaneous breathing trials for extubation: a randomized study. Therefore, this finding may due to a limited number of cases (n=461) with relatively low mortality. A P value of <0.05 was taken to indicate statistical significance. Proportional assist ventilation (PAV) is an assisted ventilation mode, which is recently being applied to wean the patients from mechanical ventilation. In the subgroup of patients undergoing PAV+, we found a greater chance of weaning success with low heterogeneity (fixed-effect, RR 1.14; 95% CI 1.051.24; I2=0%). J Thorac Dis. 1998 Jan;157(1):135-43 Meta-analysis of weaning success. Roberts C, Torgerson DJ. Detailed information of the included trials. Thorax. This protocol may particularly benefit patients who are most difficult to wean, notably those with COPD. Table S2. van Houwelingen HC, Arends LR, Stijnen T. Advanced methods in meta-analysis: multivariate approach and meta-regression. Accessibility Federal government websites often end in .gov or .mil. 1997 Aug;156(2 Pt 1):459-65. doi: 10.1164/ajrccm.156.2.9610109. Correspondence to Patient-ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation. The y-axis represents the z values, representing the accumulating statistical information. The rate of weaning success was significantly greater in patients undergoing PAV compared to patients undergoing PSV (fixed-effect, RR 1.16; 95% CI 1.071.26; I2=0.0%, Cochrans Q P value 0.72) (Fig. S3). We also performed trial sequential analysis to reduce both type 1 and type 2 errors, avoiding overestimates, and consolidating our result. BMC Med Res Methodol. 1992;145(1):1219. 1995 Nov;21(11):913-9 Fig. 2007 May;29(5):1033-56. doi: 10.1183/09031936.00010206. Three more studies were included in our meta-analysis. The results of this meta-analysis might be elucidated in light of its strengths and limitations. The spontaneous breathing trial (SBT), which assesses the patients ability to breathe while receiving minimal or no ventilator support, is used to wean patients from mechanical ventilation. Comparison of pressure support ventilation and proportional assist ventilation plus for weaning from mechanical ventilation in critically ill patients. 1994 Jul;20(6):421-4 Two [28, 32] recorded no mean physiologic score. While Kataoka et al. PRISMA Checklist. Acute Physiology and Chronic Health Evaluation II score, The Grading of Recommendations Assessment, Development, and Evaluation, Preferred Reporting Items for Systematic reviews and Meta-analysis. We constructed TSA boundaries, according to the OBrien-Fleming alpha-spending function, to assess whether the P value was statistically significant enough to show the anticipated effect or whether the analysis should be terminated early [26].

2002;57(3):2726. Front Med (Lausanne). We analyzed dichotomous variables [14], using the Mantel-Haenszel method and DerSimonian-Laird estimator, and calculated risk ratios (RRs) with 95% confidence intervals (CIs). The quality of the RCTs was appraised by HJJ and PHC using the Cochrane Risk of Bias tool [11]. -, Intensive Care Med. Crit Care 24, 556 (2020). Results of an initial clinical trial. statement and The groups were comparable with regard to endotracheal tube diameter, MV duration, the use of non-invasive ventilation (NIV) after extubation, initial severity score, age and underlying pathology, except for COPD. When the data were insufficient to reduce the risk of misinterpreting random error [40], TSA provided more information around imprecision and added a new dimension to yield firm conclusions. Article did not compare the mortality rate between proportional mode and PSV. Bethesda, MD 20894, Web Policies S3. Indian J Respir Care. Table S5.

The remaining seven studies [4, 27,28,29,30,31,32] (6 two-arm studies, 1 three-arm study) were included in our quantitative analysis. 2016;22(3):24653. Subira C, Hernandez G, Vazquez A, Rodriguez-Garcia R, Gonzalez-Castro A, Garcia C, Rubio O, Ventura L, Lopez A, de la Torre MC, et al. A subgroup analysis was conducted of the different types of PAV. Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. There was no significant difference between PAV and PSV in terms of mortality (5 studies [4, 28,29,30,31], n=461 patients, fixed-effect, RR 0.66; 95% CI 0.421.06; I2=0%, Cochrans Q P value 0.56) or weaning duration (3 studies [27, 30, 31], n=123 patients, fixed-effect, MD 0.01 (hours); 95% CI 1.301.28; I2=0%, Cochrans Q P value 0.57). Otherwise, a 30-min trial with +7 cm H2O PS was initiated with an individualized pressurization slope and trigger adjustment. S2.

Authors of studies eligible for inclusion in our review were contacted if original data were missing. J Clin Epidemiol. Chronic obstructive pulmonary disease and weaning of difficult-to-wean patients from mechanical ventilation: randomized prospective study. 2016 Oct;8(10):E1296-E1300.

Liang-Jun Ou-Yang and Po-Huang Chen have equal contribution as the first authors. 2015;19:56. Comparative Efficacy and Safety of Four Different Spontaneous Breathing Trials for Weaning From Mechanical Ventilation: A Systematic Review and Network Meta-Analysis.

Not obtained as this is a systematic review and meta-analysis of published studies. Pulmonary infection control window as a switching point for sequential ventilation in the treatment of COPD patients: a meta-analysis. The https:// ensures that you are connecting to the There was no significant difference between PAV and PSV with regard to mortality (RR 0.66; 95% CI 0.421.06; I2=0%) or weaning duration (MD 0.01 (hours); 95% CI 1.301.28; I2=0%). The secondary outcomes were as follows: the proportion of patients requiring reintubation (defined as the patient requiring reintubation within 48h after extubation), in-hospital mortality, ICU length of stay (the time from randomization to ICU discharge), weaning duration (the time from randomization to extubation), and ventilation duration (the time from intubation to extubation). Evidence supporting clinical use of proportional assist ventilation: a systematic review and meta-analysis of clinical trials. PubMed

Comparison between pressure support ventilation and T-piece in spontaneous breathing trials. 2006;333(7568):597600.

Debray TPA, Moons KGM, Riley RD. PubMedGoogle Scholar. 2). 2017 Apr 24;12:1255-1267. doi: 10.2147/COPD.S126736. Assessment of risk of bias with the Cochrane Risk of Bias tool. 2010;1(2):14961. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 2017;151(1):16680. 2018;52(suppl 62):OA3295. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Through reducing patients work of breathing and saving their physical energy, they can wean more efficiently, thereby improving the weaning success rate and reducing the length of ICU and hospital stay [8]. 2009;29(6):4155 quiz 41 p following 55. Studies published in English and Chinese language were selected. 2019;10:ED000142. Two reviewers (HJJ and PHC) independently extracted the data from all included articles. Therefore, we conducted a more comprehensive meta-analysis using state-of-the-art statistical methods.