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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; Deborah J. Cook, MD
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*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@mcmaster.ca



Chest. 2001;120(6_suppl):425S-437S. doi:10.1378/chest.120.6_suppl.425S
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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.


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