Any intensive care unit (ICU) ventilator will have the option to use automatic tube compensation (ATC) to counteract the pressure reduction in resistance caused by the endotracheal tube. The purpose of this research was to evaluate the efficacy of ATC versus alternative patient-triggered forms of support in terms of spontaneous breathing trials (SBTs) and successful extubation. Using the following search phrases as MeSH terms in all fields, 2 authors (JB and PCF) searched PubMed, Web of Science, and Cochrane from their respective databases’ founding dates (January 1, 1996) to May 26, 2021. “Tube Automatic Adjustment” Randomized controlled trials with participants aged 16 and up that involved SBTs were considered. Research conducted in a crossover design, on children, in animals, in test lungs, or using computer simulations were not included, nor were studies conducted in languages other than French, Spanish, or English. Also excluded were studies published only in abstract or letter form, as well as reviews. A frequentist network meta-analysis was performed to better understand the impact of ATC on SBT and extubation outcomes. Successful SBT was defined as patients meeting established criteria for SBT tolerance, regardless of whether or not extubation occurred afterward. For extubation to be considered successful, the patient needed to go 48 hours without requiring re-intubation, noninvasive ventilation, or showing signs of respiratory distress. Effect sizes were reported as relative risks or mean differences for categorical and continuous variables in the pooled analyses conducted using random-effect models. All treatments were ranked using P-scores, and the most promising intervention was singled out. The final tally was 234 documents rescued, but only 7 were usable. ATC100+PEEP<7.5 and PS10+PEEP<7.5 outperformed T-piece in terms of SBT success. In a similar vein, PS10+PEEP<7.5 was the most promising treatment (P-score: 0.90). ATC100+PEEP<7.5 cm H2O considerably outperformed PEEP <7.5 and the T-piece in terms of extubation success. Similarly, it had an exceptionally high chance of being the best option (P-score= 0.90). In conclusion, ATC has the highest likelihood of extubation success, but SBT has the highest success rate.
Source: rc.rcjournal.com/content/67/10/1335
