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Meta-Analysis
. 2014 May 27;2014(5):CD006056.
doi: 10.1002/14651858.CD006056.pub2.

Pressure support versus T-tube for weaning from mechanical ventilation in adults

Magdaline T Ladeira  1 , Flávia M R Vital, Régis B Andriolo, Brenda N G Andriolo, Alvaro N Atallah, Maria S Peccin
Affiliations
Meta-Analysis

Pressure support versus T-tube for weaning from mechanical ventilation in adults

Magdaline T Ladeira et al. Cochrane Database Syst Rev. .

Abstract

Background: Mechanical ventilation is important in caring for patients with critical illness. Clinical complications, increased mortality, and high costs of health care are associated with prolonged ventilatory support or premature discontinuation of mechanical ventilation. Weaning refers to the process of gradually or abruptly withdrawing mechanical ventilation. The weaning process begins after partial or complete resolution of the underlying pathophysiology precipitating respiratory failure and ends with weaning success (successful extubation in intubated patients or permanent withdrawal of ventilatory support in tracheostomized patients).

Objectives: To evaluate the effectiveness and safety of two strategies, a T-tube and pressure support ventilation, for weaning adult patients with respiratory failure that required invasive mechanical ventilation for at least 24 hours, measuring weaning success and other clinically important outcomes.

Search methods: We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6); MEDLINE (via PubMed) (1966 to June 2012); EMBASE (January 1980 to June 2012); LILACS (1986 to June 2012); CINAHL (1982 to June 2012); SciELO (from 1997 to August 2012); thesis repository of CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) (http://capesdw.capes.gov.br/capesdw/) (August 2012); and Current Controlled Trials (August 2012).We reran the search in December 2013. We will deal with any studies of interest when we update the review.

Selection criteria: We included randomized controlled trials (RCTs) that compared a T-tube with pressure support (PS) for the conduct of spontaneous breathing trials and as methods of gradual weaning of adult patients with respiratory failure of various aetiologies who received invasive mechanical ventilation for at least 24 hours.

Data collection and analysis: Two authors extracted data and assessed the methodological quality of the included studies. Meta-analyses using the random-effects model were conducted for nine outcomes. Relative risk (RR) and mean difference (MD) or standardized mean difference (SMD) were used to estimate the treatment effect, with 95% confidence intervals (CI).

Main results: We included nine RCTs with 1208 patients; 622 patients were randomized to a PS spontaneous breathing trial (SBT) and 586 to a T-tube SBT. The studies were classified into three categories of weaning: simple, difficult, and prolonged. Four studies placed patients in two categories of weaning. Pressure support ventilation (PSV) and a T-tube were used directly as SBTs in four studies (844 patients, 69.9% of the sample). In 186 patients (15.4%) both interventions were used along with gradual weaning from mechanical ventilation; the PS was gradually decreased, twice a day, until it was minimal and periods with a T-tube were gradually increased to two and eight hours for patients with difficult and prolonged weaning. In two studies (14.7% of patients) the PS was lowered to 2 to 4 cm H2O and 3 to 5 cm H2O based on ventilatory parameters until the minimal PS levels were reached. PS was then compared to the trial with the T-tube (TT).We identified 33 different reported outcomes in the included studies; we took 14 of them into consideration and performed meta-analyses on nine. With regard to the sequence of allocation generation, allocation concealment, selective reporting and attrition bias, no study presented a high risk of bias. We found no clear evidence of a difference between PS and TT for weaning success (RR 1.07, 95% CI 0.97 to 1.17, 9 studies, low quality of evidence), intensive care unit (ICU) mortality (RR 0.81, 95% CI 0.53 to 1.23, 5 studies, low quality of evidence), reintubation (RR 0.92, 95% CI 0.66 to 1.26, 7 studies, low quality evidence), ICU and long-term weaning unit (LWU) length of stay (MD -7.08 days, 95% CI -16.26 to 2.1, 2 studies, low quality of evidence) and pneumonia (RR 0.67, 95% CI 0.08 to 5.85, 2 studies, low quality of evidence). PS was significantly superior to the TT for successful SBTs (RR 1.09, 95% CI 1.02 to 1.17, 4 studies, moderate quality of evidence). Four studies reported on weaning duration, however we were unable to combined the study data because of differences in how the studies presented their data. One study was at high risk of other bias and four studies were at high risk for detection bias. Three studies reported that the weaning duration was shorter with PS, and in one study the duration was shorter in patients with a TT.

Authors' conclusions: To date, we have found evidence of generally low quality from studies comparing pressure support ventilation (PSV) and with a T-tube. The effects on weaning success, ICU mortality, reintubation, ICU and LWU length of stay, and pneumonia were imprecise. However, PSV was more effective than a T-tube for successful spontaneous breathing trials (SBTs) among patients with simple weaning. Based on the findings of single trials, three studies presented a shorter weaning duration in the group undergoing PS SBT, however a fourth study found a shorter weaning duration with a T-tube.

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Conflict of interest statement

None known

Figures

1
1
Study flow diagram. Search reran in December 2013.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Funnel plot of comparison: 1 Pressure support versus T‐tube, outcome: 1.1 Weaning success.
1.1
1.1. Analysis
Comparison 1 Pressure support versus T‐tube, Outcome 1 Weaning success.
1.2
1.2. Analysis
Comparison 1 Pressure support versus T‐tube, Outcome 2 ICU mortality.
1.3
1.3. Analysis
Comparison 1 Pressure support versus T‐tube, Outcome 3 Reintubation.
1.4
1.4. Analysis
Comparison 1 Pressure support versus T‐tube, Outcome 4 ICU or LWU length of stay.
1.5
1.5. Analysis
Comparison 1 Pressure support versus T‐tube, Outcome 5 Pneumonia.
1.6
1.6. Analysis
Comparison 1 Pressure support versus T‐tube, Outcome 6 Successful spontaneous breathing trial.
1.7
1.7. Analysis
Comparison 1 Pressure support versus T‐tube, Outcome 7 Respiratory rate (RR).
1.8
1.8. Analysis
Comparison 1 Pressure support versus T‐tube, Outcome 8 Tidal volume (VT).
1.9
1.9. Analysis
Comparison 1 Pressure support versus T‐tube, Outcome 9 Rapid and shallow breathing index (RSBI).
1.10
1.10. Analysis
Comparison 1 Pressure support versus T‐tube, Outcome 10 Time of weaning from MV (Duration of weaning).
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References

References to studies included in this review

Brochard 1994 {published data only}
    1. Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. American Journal of Respiratory and Critical Care Medicine 1994;150:896‐903. [MEDLINE: ] - PubMed
Esteban 1995 {published data only}
    1. Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdú I, et al. A comparison of four methods of weaning patients from mechanical ventilation. New England Journal of Medicine 1995;332(6):345‐50. [MEDLINE: ] - PubMed
Esteban 1997 {published data only}
    1. Esteban A, Alia I, Gordo F, Fernandez R, Solsona JF, Vallverdu I, et al. Extubation outcome after spontaneous breathing trials with t‐tube or pressure support ventilation. American Journal of Respiratory and Critical Care Medicine 1999;159:512‐8. [MEDLINE: ] - PubMed
Haberthur 2002 {published data only}
    1. Haberthür C, Mols G, Elsasser S, Bingisser R, Stocker R, Guttmann J. Extubation after breathing trials with automatic tube compensation, T‐tube, or pressure support ventilation. Acta Anaesthesiologica Scandinavica 2002;46(8):973‐9. [MEDLINE: ] - PubMed
Koh 2000 {published data only}
    1. Koh Y, Hong SB, Lim CM, Lee SD, Kim WS, Kim DS, Kim WD. Effect of an additional 1‐hour T‐piece trial on weaning outcome at minimal pressure support. Journal of Critical Care 2000;15(2):41‐5. [PUBMED: 10877363] - PubMed
Koksal 2004 {published data only}
    1. Koksal GM, Sayilgan C, Sen O, Oz H. The effects of different weaning modes on the endocrine stress response. Critical Care 2004;8(1):31‐4. [MEDLINE: ] - PMC - PubMed
Matić 2004 {published data only}
    1. Matić I, Majerić‐Kogler V. Comparison of pressure support and t‐tube weaning from mechanical ventilation: Randomized prospective study. Croatian Medical Journal 2004;45(2):162‐6. [MEDLINE: ] - PubMed
Matić 2007 {published data only}
    1. Matić I, Davorin D, Majerić‐Kogler V, Jurjević M, Mirković I, Vucinić NM. Chronic obstructive pulmonary disease and weaning of difficult‐to‐wean patients from mechanical ventilation: Randomized prospective study. Croatian Medical Journal 2007;48(1):51‐8. [PUBMED: 17309139] - PMC - PubMed
Vitacca 2001 {published data only}
    1. Vitacca M, Vianello A, Colombo D, Clini E, Porta R, Bianchi L, et al. Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days. American Journal of Respiratory and Critical Care Medicine 2001;164(2):225‐30. [MEDLINE: ] - PubMed

References to studies excluded from this review

Cabello 2010 {published data only}
    1. Cabello B, Thille A, Roche‐Campo F, Brochard L, Gómez F, Mancebo J. Physiological comparison of three spontaneous breathing trials in difficult‐to‐wean patients. Intensive Care Medicine 2010;36:1171‐9. [DOI: ] - PubMed
Colombo 2007 {published data only}
    1. Colombo T, Boldrini AF, Juliano S, Juliano M, Houly J, Gebara O, et al. Implementation, assessment and comparison of the T‐tube and pressure‐ support weaning protocols applied to the intensive care unit patients who had received mechanical ventilation for more than 48 hours [Implementação, avaliação e comparação dos protocolos de desmame com tubo‐T e pressão suporte associada à pressão expiratória final positiva em pacientes submetidos à ventilação mecânica por mais de 48 horas em unidade de terapia intensiva]. Revista Brasileira de Terapia Intensiva 2007;19(1):31‐7. - PubMed
Costa 2005 {published data only}
    1. Costa A, Rieder M, Vieira S. Weaning from mechanical ventilation by using pressure support or T‐tube ventilation. Comparison between patients with and without heart disease. [Desmame da ventilação mecânica utilizando pressão de suporte ou tubo T. Comparação entre pacientes cardiopatas e não cardiopatas]. Arquivos Brasileiros de Cardiologia 2005;85(1):On Line. [DOI: 10.1590/S0066-782X2005001400007] - DOI - PubMed
Emmerich 1997 {published data only}
    1. Emmerich J, Vicêncio S, Siqueira H, Simäo A, Bernhoeft C, Souza W. A comparison among three methods of weaning ventilatory support: T‐piece versus S‐IMV versus PSV [Estudo comparativo entre três modalidades de desmame do suporte ventilatório: tradicional (tubo em "T") versus S‐IML versus PSV]. Revista Brasileira de Terapia Intensiva 1997;9(4):167‐74.
Esteban 1999 {published data only}
    1. Esteban A, Alía I, Tobin MJ, Gil A, Gordo F, Vallverdú I, et al. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. American Journal of Respiratory and Critical Care Medicine 1999;159(2):512‐8. [MEDLINE: ] - PubMed
Figueiredo 2001 {unpublished data only}
    1. Figueiredo LC. Comparison of two weaning methods in uncomplicated coronary artery bypass grafting post‐operative patients [Comparação entre dois métodos de retirada do suporte ventilatório em pacientes no pós‐operatório de cirurgia cardíaca (MD Thesis)]. Biblioteca Central da Unicamp 2001.
Goldwasser 1998 {published and unpublished data}
    1. Goldwasser R. Study on the effectiveness of two different tolerance tests on weaning from mechanical ventilation, for predicting the success of extubation in patients with chronic obstructive pulmonary disease [Estudo da eficácia de dois diferentes testes de tolerância de interrupção da ventilação mecânica para predizer o êxito da extubação em pacientes portadores de Doença Pumonar Obstrutiva Crônica]. Universidade Federal do Rio de Janeiro. Rio de Janeiro, 1998:88p.
Guntzel 2007 {published data only}
    1. Gűntzel A, Moraes R, Chiappa Z, Ferlin E, Vieira S. The effect of T‐tube and Pressure Support on Cardiorespiratory Variables and Heart Rate Variability during Weaning from Mechanical Ventilation [O efeito do tuboT e da pressão de suporte sobre variáveis cardiorespiratórias e variabilidade da frequência cardíaca durante o desmame da ventilação mecânica]. The effect of T‐tube and pressure support on cardiorespiratory variables and heart rate variability during weaning from mechanical ventilation (thesis). Porto Alegre: Porto Alegre University, 2007:1‐84.
Kuhlen 2003 {published data only}
    1. Kuhlen R, Max M, Dembinski R, Terbeck S, Jürgens E, Rossaint R. Breathing pattern and workload during automatic tube compensation, pressure support and T‐piece trials in weaning patients [2003]. European Journal Anaesthesiology 2003;20(1):10‐6. [MEDLINE: ] - PubMed
Niembro 1996 {published data only}
    1. Niembro R, Liendo A, Fisher R, Lopez J, Granillo J, Gonzáles J, et al. Comparison of T piece vs pressure support ventilation during weaning from mechanical ventilation [Pieza T vs ventilación con presión de soporte como método de retiro de la asistencia mecánica ventilatoria]. Revista de la Associación Mexicana de Medicina Critica y Terapia Intensiva 1996;10(6):254‐8. [LILACS ID: 187834]
Patel 1996 {published data only}
    1. Patel R, Petrini M, Norman J. Work of breathing and pressure‐time product on pressure support ventilation, continuous positive airway pressure, and T‐piece. Respiratory Care 1996;41(11):1013‐9.
Perren 2002 {published data only}
    1. Perren A, Domenighetti G, Mauri S, Genini F, Vizzardi N. Protocol‐directed weaning from mechanical ventilation: clinical outcome in patients randomized for a 30‐min or 120‐min trial with pressure support ventilation. Intensive Care Medicine 2002;28(8):1058‐63. [MEDLINE: ] - PubMed
Rieder 2004 {published data only}
    1. Rieder M, Costa A, Vieira S. Positive expiratory pressure as a method for mechanical ventilation weaning: a comparison between the pressure support and T‐tube methods [O uso da pressão expiratória positiva final durante o desmame da ventilação mecânica: uma comparação com os métodos de pressão de suporte e Tubo T]. CAPES thesis data 2004.
Santos 2008 {published data only}
    1. Santos L, Hoff F, Kaufmann M, Condessa R, Vieira S. Energy expenditure in weaning from mechanical ventilation [Avaliação do gasto energético durante o desmame da ventilação mecânica os modos pressão suporte e Tubo T]. Universidade Federal do Rio Grande do Sul. Porto Alegre, 2008:89p.
Sassoon 1991 {published data only}
    1. Sassoon C, Light R, Lodia R, Sieck G, Mahutte K. Pressure‐time product during continuous positive airway pressure, pressure support ventilation, and T‐piece during weaning from mechanical ventilation. American Review of Respiratory Disease 1991;143:469‐75. [MEDLINE: ] - PubMed
Schifelbain 2011 {published data only}
    1. Schifelbain LM, Vieira SR, Brauner JS, Pacheco DM, Naujorks AA. Echocardiographic evaluation during weaning from mechanical ventilation [Alterações cardio‐respiratórias em pacientes em desmame da ventilação mecânica: avaliação por ecocardiograma]. Clinics 2011;66(1):107‐11. [LILACS ID: 578605; PUBMED: 21437445] - PMC - PubMed

References to studies awaiting assessment

Jubran 2013 {published data only}
    1. Jubran A, Grant BJ, Duffner LA, Collins EG, Lanuza DM, Hoffman LA, Tobin MJ. Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation: a randomized trial. JAMA 2013;309(7):671‐7. - PMC - PubMed
Zhang 2009 {published data only}
    1. Zhang B, Qin YZ. A clinical study of rapid‐shallow‐breathing index in spontaneous breathing trial with pressure support ventilation and T‐piece. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2009;21(7):397‐401. [JAMA: 2013.159.] - PubMed

References to ongoing studies

Agarwal 2008 {published data only}
    1. Aggarwal A. Pressure support reduction versus spontaneous breathing trials in weaning from ventilation. www.controlled‐trials.com/mrct.
Pellegrini 2011 {published data only}
    1. Pellegrini J. Comparison between spontaneous breathing trials through pressure‐support ventilation or "T" tube in the weaning of mechanical ventilation in patients with chronic obstructive pulmonary disease: a randomized controlled trial. www.controlled‐trials.com 2011.

Additional references

Alia 2000
    1. Alia I, Esteban A. Weaning from mechanical ventilation. Critical Care 2000;4:72‐80. [MEDLINE: ] - PMC - PubMed
Baeza 1975
    1. Baeza OR, Wagner RB, Lowery BD. Pulmonary hyperinflation. A form of barotrauma during mechanical ventilation. The Journal of Thoracic and Cardiovascular Surgery 1975;70(5):790‐805. [MEDLINE: ] - PubMed
Blackwood 2010
    1. Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O'Halloran P. Protocolized versus non‐protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane Database of Systematic Reviews 2010, Issue 5. [DOI: 10.1002/14651858.CD006904.pub2] - DOI - PubMed
Boles 2007
    1. Boles J, Bion J, Connors A, Herridge M, Marsh B, et al. Weaning from mechanical ventilation. European Respiratory Journal 2007;29:1033‐56. - PubMed
Butler 1999
    1. Butler R, Keenan SP, Inman KJ, Sibbald WJ, Block G. Is there a preferred technique for weaning the difficult‐to‐wean patient: a systematic review of the literature. Critical Care Medicine 1999;27(11):2331‐6. [MEDLINE: ] - PubMed
Caroleo 2007
    1. Caroleo S, Agnello F, Abdallah K, Santangelo E, Amantea B. Weaning from mechanical ventilation: an open issue. Minerva Anestesiologica 2007;73(7‐8):417‐27. [PUBMED: 17637588] - PubMed
Combes 2003
    1. Combes A, Figliolini C, Trouillet JL, Kassis N, Dombret MC, Wolff M, et al. Factors predicting ventilator‐associated pneumonia recurrence. Critical Care Medicine 2003;31:1102‐7. [MEDLINE: ] - PubMed
Cook 2000
    1. Cook D, Meade M, Guyatt G, Griffith G, Booker L. Criteria for weaning from mechanical ventilation. Agency for Healthcare Research and Quality 2000;371(23):1‐4. [MEDLINE: ] - PMC - PubMed
Egger 1997
    1. Egger M, Davey‐Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphic test. BMJ 1997;315:629‐34. [MEDLINE: ] - PMC - PubMed
Eggimann 2001
    1. Eggimann P, Pittet D. Infection control in the ICU. Chest 2001;120(6):2059‐93. [MEDLINE: ] - PubMed
Ely 1996
    1. Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, et al. Effect of the duration of mechanical ventilation on identifying patients capable of breathing spontaneously. New England Journal of Medicine 1996;335:1864‐9. [MEDLINE: ] - PubMed
Epstein 1997
    1. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;112(1):186‐92. [PUBMED: 9228375] - PubMed
Epstein 2000
    1. Epstein SK. Weaning parameters. Respiratory Care Clinics of North America 2000;6:253‐301. [MEDLINE: ] - PubMed
Epstein 2001
    1. Epstein SK. Controversies in weaning from mechanical ventilation. Journal of Intensive Care Medicine 2001;16:270‐86.
Esen 1992
    1. Esen F, Denkel T, Telci L, Kesecioglu J, Tutuncu AS, et al. Comparison of pressure support ventilation and intermittent mandatory ventilation during weaning in patients with acute respiratory failure. Advances in Experimental Medicine and Biology 1992;317:371‐6. [MEDLINE: ] - PubMed
Esteban 1994
    1. Esteban A, Alía I, Ibañez J, Benito S, Tobin M. Modes of Mechanical Ventilation and Weaning. Chest 1994;106:1188‐93. [DOI: ; CHEST 106.4.1188] - PubMed
Esteban 2002
    1. Esteban A, Anzueto A, Frutos F, AlÍa I, Brochard L, Stewart TE, et al. Mechanical Ventilation International Study Group. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28‐day international study. JAMA 2002;287(3):345‐55. [PUBMED: 11790214] - PubMed
Esteban 2008
    1. Esteban A, Ferguson N, Meade M, Frutos‐Vivar F, Apezteguia C, et al. Evolution of mechanical ventilation in response to clinical research. American Journal of Respiratory and Critical Care Medicine 2008;177:170‐7. - PubMed
Ezingeard 2006
    1. Ezingeard E, Diconne E, Guyomarcêh S, Venet C, Page D, Gery P, et al. Weaning from mechanical ventilation with pressure support in patients failing a T‐tube trial of spontaneous breathing. Intensive Care Medicine 2006;32(1):165‐9. [PUBMED: 16283162] - PubMed
Fagon 1996
    1. Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996;275(11):866‐9. [MEDLINE: ] - PubMed
Fleiss 1986
    1. Fleiss JL. Analysis of data from multiclinic trials. Controlled Clinical Trials 1986;7(4):267‐75. [MEDLINE: ] - PubMed
Funk 2010
    1. Funk GC, Anders S, Breyer MK, Burghuber OC, Edelmann G, Heindl W, et al. Incidence and outcome of weaning from mechanical ventilation according to new categories. European Respiratory Journal 2010;35(1):88‐94. [PUBMED: 19541716] - PubMed
Garnacho‐Montero2005
    1. Garnacho‐Montero J, Amaya‐Villar R, García‐Garmendia JL, Madrazo‐Osuna J, Ortiz‐Leyba C. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Critical Care Medicine 2005;33(2):349‐54. [MEDLINE: ] - PubMed
Girard 2008
    1. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 2008;371(9607):126‐34. [DOI: 10.1016/S0140-6736(08)60105-1; PUBMED: 18191684] - DOI - PubMed
Gonçalves 2012
    1. Gonçalves E, Silva E, Basile A, Auxiliadora M, Nicolini E, Gastaldi A. Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation. Revista Brasileira de Fisioterapia 2012; Vol. 16, issue 5:368‐74. [DOI: 10.1590/S1413-35552012005000037] - DOI - PubMed
Higgins 2002
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21:1539‐58. [MEDLINE: ] - PubMed
Higgins 2011
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Cochrane Database of Systematic Reviews 2011.
Hozo 2005
    1. Hozo S, Djulbegovic B, HozoI I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology 2005;5:13. [DOI: 10.1186/1471-2288-5-13] - DOI - PMC - PubMed
Knaus 1985
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical Care Medicine 1985;13(10):818‐29. [PUBMED: 3928249] - PubMed
Kollef 1997
    1. Kollef MH, Shapiro SD, Silver P, John RE, Prentice D, Sauer S, et al. A randomized, controlled trial of protocol‐directed versus physician‐directed weaning from mechanical ventilation. Critical Care Medicine 1997;25:567‐74. [MEDLINE: ] - PubMed
Le Bourdelles 1994
    1. Bourdelles G, Viires N, Boczkowski J, Seta N, Pavlovic D, Aubier M. Effects of mechanical ventilation on diaphragmatic contractile properties in rats. American Journal of Respiratory and Critical Care Medicine 1994;49:1539‐44. [MEDLINE: ] - PubMed
Le Gall 1993
    1. Gall JR. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957‐63. - PubMed
Levine 2008
    1. Levine S, Nguyen T, Taylor N, Friscia ME, Budak MT, Rothenberg P, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. New England Journal of Medicine 2008;27(13):1327‐35. [PUBMED: PMID: 18367735] - PubMed
Luetz 2012
    1. Luetz A, Goldmann A, Weber‐Carstens S, Spies C. Weaning from mechanical ventilation and sedation. Current Opinion Anaesthesiology 2012;25(2):164‐9. - PubMed
MacIntyre 2001
    1. MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, et al. Evidence‐based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001;120(6 Suppl):375S‐95S. [MEDLINE: ] - PubMed
MacIntyre 2012
    1. MacIntyre NR. Evidence‐based assessments in the ventilator discontinuation process. Respiratory Care 2012;57(10):1611‐8. [PUBMED: 23013898] - PubMed
Marelich 2000
    1. Marelich GP, Murin S, Battistella F, Inciardi J, Vierra T, Roby M. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses. Effect on weaning time and incidence of ventilator associated pneumonia. Chest 2000;118:459‐65. [MEDLINE: ] - PubMed
Marini 1998
    1. Marini JJ, Slutsky AS. Physiological basis of ventilatory support. Vol. 118, New York: Marcel Dekker Inc, 1998.
Meade 2001
    1. Meade M, Guyatt G, Sinuff T, Griffith L, Hand L, Toprani G, et al. Trials comparing alternative weaning modes and discontinuation assessments. Chest 2001;120:425S‐37S. [MEDLINE: ] - PubMed
Michelson 1991
    1. Michelson A, Kamp HD, Schuster B. Sinusitis in long‐term intubated, intensive care patients: nasal versus oral intubation. Der Anaesthesist 1991;40(2):100‐4. [MEDLINE: ] - PubMed
Morehead 2000
    1. Morehead RS, Pinto SJ. Ventilator‐associated pneumonia. Archives of Internal Medicine 2000;160:1926‐36. [MEDLINE: ] - PubMed
Nathan 1993
    1. Nathan SD, Ishaaya AM, Koerner SK, Belman MJ. Prediction of minimal pressure support during weaning from mechanical ventilation. Chest 1993;103(4):1215‐9. [PUBMED: 8131468] - PubMed
Oxman 1992
    1. Oxman AD, Guyatt GH. A consumer's guide to subgroup analyses. Annals of Internal Medicine 1992;116:78‐84. [MEDLINE: ] - PubMed
Patel 2009
    1. Patel K, Ganatra K, Bates J, Young M. Variation in the rapid shallow breathing index associated with common measurement techniques and conditions. Respiratory Care 2009;54(11):1462‐6. - PubMed
Petersen 1983
    1. Petersen GW, Baier H. Incidence of pulmonary barotrauma in a medical ICU. Critical Care Medicine 1983;11(2):67‐9. [MEDLINE: ] - PubMed
Peňuelas 2011
    1. Penuelas O, Frutos‐Vivar F, Fernández C, Anzueto A, Epstein SK, Apezteguia C, et al. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. American Journal of Respiratory and Critical Care Medicine 2011;184:430‐7. [DOI: 10.1164/rccm.201011-1887OC.; MEDLINE: ] - DOI - PubMed
Pingleton 1988
    1. Pingleton SK. Complications of acute respiratory failure. American Review of Respiratory Disease 1988;137:1463‐93. [MEDLINE: ] - PubMed
Powers 2002
    1. Powers SK, Shanely RA, Coombes JS, Koesterer TJ, McKenzie M, Gammeren D, et al. Mechanical ventilation results in progressive contractile dysfunction in the diaphragm. Journal of Applied Physiology 2002;92:1851‐8. [MEDLINE: ] - PubMed
Rello 1991
    1. Rello J, Quintana E, Ausina V, Castella J, Luquin M, Net A, et al. Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest 1991;100:439‐44. [MEDLINE: ] - PubMed
Santos 2007
    1. Santos L, Borges M, Figueirêdo L, Guedes C, Vian B, Kappaz K, Araújo S. Comparison among Three Methods to Measure the Rapid Shallow Breathing Index in Patients Submitted to Weaning from Mechanical Ventilation [Comparação entre Três Métodos de Obtenção do Índicede Respiração Rápida e Superficial em Pacientes Submetidos ao Desmame da Ventilação Mecânica]. Revista Brasileira de Terapia Intensiva 2007;19(3):331‐6. - PubMed
Schuster 1984
    1. Schuster DP, Rowley H, Feinstein S, McGue MK, Zuckerman GR. Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit. The American Journal of Medicine 1984;76(4):623‐30. [MEDLINE: ] - PubMed
Sellares 2011
    1. Sellares J, Ferrer M, Cano E, Loureiro H, Valencia M, Torres A. Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU. Intensive Care Medicine 2011;37(5):775‐84. [PUBMED: 21373820.] - PubMed
Tonnelier 2011
    1. Tonnelier A, Tonnelier JM, Nowak E, Gut‐Gobert C, Prat G, Renault A, et al. Clinical relevance of classification according to weaning difficulty. Respiratory Care 2011;56(5):583‐90. [PUBMED: PMID: 21276313 ] - PubMed
van Zanten 2005
    1. Zanten AR, Dixon JM, Nipshagen MD, Bree R, Girbes AR, Polderman KH. Hospital‐acquired sinusitis is a common cause of fever of unknown origin in orotracheally intubated critically ill patients. Critical Care 2005;9(5):583‐90. [MEDLINE: ] - PMC - PubMed
Yusuf 1991
    1. Yusuf S, Wittes J, Probstfield J, Tyroler HA. Analysis and interpretation of treatment effects in subgroups of patients in randomized clinical trials. JAMA 1991;266:93‐8. [MEDLINE: ] - PubMed

References to other published versions of this review

Ladeira 2006
    1. Ladeira MT, Burns KEA, Atallah ÁN, Vital FMR, Andriolo RB, Soares B. Pressure support versus T tube for weaning from mechanical ventilation in adults. Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD006056] - DOI - PMC - PubMed

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