6/29/23, 11:57 PM Subira Pathway Feedback Search Clinical Topics Home Studies Subira Subira Trial question What is the effect of spontaneous breathing trial of pressure support ventilation strategy among patients receiving mechanical ventilation? Study design Multi-center Open label RCT Population Characteristics of study participants 37.0% female N = 1153 63.0% male 1153 patients (428 female, 725 male) Inclusion criteria: adult patients deemed ready for weaning after at least 24 hours of mechanical ventilation Key exclusion criteria: tracheostomies or do-not-reintubate orders Interventions N=575 a pressure support ventilation strategy (a 30-minute spontaneous breathing trial with 8- cmH O pressure support ventilation) N=578 a T-piece ventilation strategy (2 hours of T-piece spontaneous breathing trial) Primary outcome Successful extubation 82.3 % 82.3 74 61.7 % 41.1 % Significant increase 20.6 % https://web.pathway.md/studies/recgPJ52envfElEm8 1/2 6/29/23, 11:57 PM Subira Pathway NNT = 12 0.0 % A pressure support ventilation strategy A T-piece ventilation strategy Significant increase in successful extubation (82.3% vs. 74%; AD 8.2%, 95% CI 3.4 to 13) Secondary outcomes No significant difference in reintubation (11.1% vs. 11.9%; ARD -0.8, 95% CI -4.8 to 3.1) No significant difference in ICU length of stay (9 days vs. 10 days; AD -0.3 days, 95% CI -1.7 to 1.1) Significant decrease in death at 90 days (13.2% vs. 17.3%; HR 0.74, 95% CI 0.55 to 0.99) Safety outcomes No significant differences in hemodynamic shock, agitation, airway obstruction, difficulty managing secretions. Significant differences in death in the hospital (10.4% vs. 14.9%), aspiration (1.7% vs. 5.2%), cardiac arrest (1.7% vs. 5.1%). Conclusion In adult patients deemed ready for weaning after at least 24 hours of mechanical ventilation, a pressure support ventilation strategy was superior to a T-piece ventilation strategy with respect to successful extubation. Reference Carles Subir , Gonzalo Hern ndez, Ant nia V zquez et al. Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA. 2019 Jun 11;321(22):2175-2182. Open reference URL https://web.pathway.md/studies/recgPJ52envfElEm8 2/2