Studies on methods of weaning from mechanical ventilation
| Extubation from low rate IPPV versus extubation after endotracheal CPAP | |
| Kimet al (n = 27)7, Kimet al (n = 60)8, Tapiaet al (n = 87)9 | |
| Cumulative analysis10 | Relative risk (RR) 0.10 (95% CI, 0.01 to 0.78), risk difference (RD) −0.201 (95% CI, −0.319 to −0.083). The use of a period of ETT CPAP before extubation confers no advantage over direct extubation. Direct extubation from low rate IPPV is associated with increased chance of successful extubation |
| Conventional IPPV versus synchronised ventilation (PTV/SIMV) | |
| Chan et al (n = 40)11, Donn et al (n = 30)12, Bernstein et al (n = 327)13, Chen et al (n = 77)14 | |
| Cumulative analysis15 | Duration of ventilation noted to be shorter with either PTV or SIMV in all studies (weighted mean difference, 45.2 hours; 95% Cl −78.8 to −12.1) |
| PTV versus SIMV | |
| Chan et al (n = 40)16, Dimitriou et al (n = 40)17 | |
| Cumulative analysis15 | Duration of ventilation shorter with PTV than SIMV (weighted mean difference, 42.4 hours; 95% Cl, −9.6 to 94.4) |
| Volume controlled versus pressure limited ventilation | |
| Sinha et al (n = 50)18, Piotrowski et al (n = 60)19 | |
| Analysis | Duration of weaning (mean time, 65.6 v 125.6 hours; p < 0.001) and duration of ventilation (mean time, 12.4v 161.9 hours; p < 0.001) shortened in volume controlled with fewer complications |
| Extubation to head box versus nasal CPAP | |
| Engelke et al (n = 19)20, Higgins et al (n = 58)21, Chan et al (n = 60)22, So et al (n = 50)23, Annibale et al (n = 124)24, Tapia et al (n = 87)9, Davis et al (n = 92)25, Robertson et al (n = 58)26 | |
| Cumulative analysis27 | Extubation to NCPAP leads to a lower “failure” rate but future studies required with refinement for gestational age and method of CPAP administration |
CI, confidence interval; CPAP, continuous positive airway pressure; ETT, endotracheal tube; IPPV, intermittent positive pressure ventilation; NCPAP, nasal CPAP; PTV, patient triggered ventilation; SIMV, synchronised intermittent mandatory ventilation.