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Trials comparing alternative weaning modes and discontinuation assessments Meade M; Guyatt G; Sinuff T; Griffith L; Hand L; Toprani G; Cook DJChest 2001[Dec]; 120 (6 Suppl): 425S-37SWe 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.|*Respiration, Artificial/methods[MESH]|*Ventilator Weaning/methods[MESH]|Evidence-Based Medicine[MESH]|Humans[MESH]|Randomized Controlled Trials as Topic[MESH]|Time Factors[MESH] |
