Summary of findings for the main comparison. Pressure support versus T‐tube for weaning from mechanical ventilation in adults.
| Pressure support versus T‐tube for weaning from mechanical ventilation in adults | ||||||
| Patient or population: patients on weaning from mechanical ventilation in adults. Settings: ICU or LWU length of stay. Intervention: pressure support versus T‐tube. | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Pressure support versus T‐tube | |||||
| Weaning success Follow‐up: mean 24 hours | Study population | RR 1.07 (0.97 to 1.17) | 935 (9 studies) | ⊕⊕⊝⊝ low1,2 | The physicians need to take into consideration the age, baseline disease, duration of mechanical ventilation before weaning | |
| 730 per 1000 | 781 per 1000 (708 to 855) | |||||
| Low | ||||||
| 600 per 1000 | 642 per 1000 (582 to 702) | |||||
| High | ||||||
| 950 per 1000 | 1000 per 1000 (922 to 1000) | |||||
| ICU mortality | Study population | RR 0.81 (0.53 to 1.23) | 725 (5 studies) | ⊕⊕⊝⊝ low1,2,3 | The physicians need to take into consideration the age of patients, disease severity, duration of mechanical ventilation before weaning, baseline disease (COPD), cause of respiratory failure | |
| 125 per 1000 | 101 per 1000 (66 to 154) | |||||
| Low | ||||||
| 50 per 1000 | 41 per 1000 (26 to 62) | |||||
| High | ||||||
| 200 per 1000 | 162 per 1000 (106 to 246) | |||||
| Reintubation Follow‐up: mean 48 hours | Study population | RR 0.92 (0.66 to 1.26) | 823 (7 studies) | ⊕⊕⊝⊝ low3,4 | The physicians need to take into consideration the age, time of mechanical ventilation, before weaning | |
| 159 per 1000 | 146 per 1000 (105 to 200) | |||||
| Low | ||||||
| 50 per 1000 | 46 per 1000 (33 to 63) | |||||
| High | ||||||
| 200 per 1000 | 184 per 1000 (132 to 252) | |||||
| ICU or LWU length of stay (days) | The mean ICU or LWU length of stay (days) in the intervention groups was 7.08 lower (16.26 lower to 2.1 higher) | 118 (2 studies) | ⊕⊕⊝⊝ low1,2,5,6 | The physicians need to take into consideration the age, time of mechanical ventilation, weaning process (prolonged weaning) and baseline disease | ||
| Pneumonia | Study population | RR 0.67 (0.08 to 5.85) | 118 (2 studies) | ⊕⊝⊝⊝ very low3,7,8 | The physicians need to take into consideration the time of mechanical ventilation | |
| 82 per 1000 | 55 per 1000 (7 to 480) | |||||
| Low | ||||||
| 10 per 1000 | 7 per 1000 (1 to 58) | |||||
| High | ||||||
| 200 per 1000 | 134 per 1000 (16 to 1000) | |||||
| Successful spontaneous breathing trial Follow‐up: mean 2 hours | Study population | RR 1.09 (1.02 to 1.17) | 940 (4 studies) | ⊕⊕⊕⊝ moderate9 | The physicians need to take into consideration the time of mechanical ventilation, age of patients, disease severity | |
| 732 per 1000 | 798 per 1000 (747 to 857) | |||||
| Low | ||||||
| 500 per 1000 | 545 per 1000 (510 to 585) | |||||
| High | ||||||
| 800 per 1000 | 872 per 1000 (816 to 936) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Two studies with high and moderate risk of bias in at least two items of methodological quality. 2 Confidence intervals include the unit (1), and P > 0.05. 3 Large confidence interval. 4 Funnel plot asymmetric. 5 Inconsistency test > 50%, but with the same direction of effect. 6 Reduction of seven days in the ICU stay is considered a large effect. 7 Two studies were considered high risk of bias in at least one item of methological quality. 8 Opposite effect directions, but inconsistency test < 50%. 9 One of four studies was considered high risk of bias in one item of methological quality. Two studies were considered unclear risk of bias in at least one item of methodological quality.