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(Chest. 2001;120:425S-437S.)
© 2001 American College of Chest Physicians

Trials Comparing Alternative Weaning Modes and Discontinuation Assessments*

Maureen Meade, MD; Gordon Guyatt, MD; Tasnim Sinuff, MD; Lauren Griffith, MSc; Lori Hand, RRT; Gemini Toprani, RRT and Deborah J. Cook, MD

* From the Departments of Medicine (Drs. Meade, Guyatt, Sinuff, and Cook) and Clinical Epidemiology & Biostatistics (Mss. Griffith and Hand), McMaster University, Hamilton, Ontario, Canada; and the Department of Respiratory Therapy (Ms. Toprani), Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada.

Correspondence to: D.J. Cook, MD, McMaster University, Faculty of Health Sciences Center, Department of Clinical Epidemiology & Biostatistics, 1200 Main St West, Hamilton, Ontario, Canada; e-mail: debcook{at}mcmaster.ca

We identified 16 randomized controlled trials (RCTs) of methods for weaning patients from mechanical ventilation, 8 of which were trials of discontinuation assessment strategies, 5 of which were trials of stepwise reduction in mechanical ventilatory support, and 3 of which were trials comparing alternative ventilation modes for weaning periods lasting < 48 h. We found that different thresholds for deciding when a patient is ready for a trial of spontaneous breathing, different criteria for a successful trial, and different thresholds for extubation may overwhelm the impact of alternative ventilation strategies. Nevertheless, the results of these studies suggest the possibility that multiple daily T-piece weaning or pressure support may be superior to synchronized intermittent mandatory ventilation. Other RCTs suggest that early extubation with the back-up institution of noninvasive positive-pressure ventilation as needed may be a useful strategy in selected patients.

Key Words: extubation • mechanical ventilation • meta-analysis • methods • modes • reintubation • systematic reviews • weaning




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