Article Data

  • Views 3555
  • Dowloads 243

Systematic reviews

Open Access

Role of Automatic Tube Compensation as Spontaneous Breathing Trial in Critically Ill Patients: A Systematic Review and Meta-Analysis

  • Yu Chen1
  • Xu Tian2
  • Chun-Mei Luo1
  • Shu-Lan Luo1
  • Ling Lin1
  • María F. Jiménez-Herrera3

1Department of orthopaedics, the Second Affiliated Hospital of Army Medical University, Chongqing, P. R. China

2Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, P. R. China

3Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain

DOI: 10.22514/sv.2020.16.0053 Vol.16,Issue 2,October 2020 pp.20-28

Published: 28 October 2020

*Corresponding Author(s): Xu Tian E-mail:
*Corresponding Author(s): María F. Jiménez-Herrera E-mail:


Objectives: The role of automatic tube compensation (ATC) compared to other spontaneous breathing trials (SBTs) in critically ill receiving mechanical ventilation remains uncertain. The aim of this meta-analysis was to determine the role of ATC in critically ill patients compared to alternative SBT techniques. Methods: We searched PubMed, Cochrane Library, and Embase to capture all potential randomized controlled trials (RCTs) investigating the comparative efficacy of ATC related to other SBT techniques including pressure support (PS), T-piece, continuous positive airway pressure (CPAP) from their inception to February 2020. Primary outcomes were successful extubation rate. Duration of weaning, intensive care unit (ICU) stay, hospital stay, and hospital mortality was regarded as secondary outcomes. We used a risk ratio with accompanying 95% confidence interval (CI) to express estimates. Reviewer Manager (RevMan) 5.1.0 was used to complete all statistical analyses. Results: We included 13 studies enrolling 1117 patients in the final analysis. Pooled results indicated no significant difference when ATC plus CPAP (ATC/CAPA) compared to PS (6 RCTs; 572 patients; risk ratio [RR], 1.15; 95% confidence interval [CI], 1.00 to 1.31), ATC versus T-piece (2 RCTs; 157 patients; RR, 1.14; 95% CI, 0.93 to 1.40), ATC plus PS (ATC/PS) versus PS alone (1 RCTs; 100 patients; RR, 1.15; 95% CI, 0.98 to 1.35), ATC/CPAP versus CPAP alone (3 RCTs; 247 patients; RR, 1.12; 95% CI, 0.97 to 1.29) in terms of successful extubation. Additionally, ATC was also not superior to PS, T-piece, or CPAP in improving the rate of reintubation, the duration of weaning, ICU stay, hospital stay, and hospital mortality. Conclusions: Compared to alternative SBT techniques including PSV and T-piece, ATC may have comparable predictive power of successful extubation in critically ill patients. However, a definite conclusion on this topic can not be drawn due to limited data. Therefore, further studies were required to establish our findings due to limited number of eligible studies and small accumulated sample size.


Automatic tube compensation, Spontaneous breathing trials, Critical illness, Systematic review, Meta-analysis

Cite and Share

Yu Chen,Xu Tian,Chun-Mei Luo,Shu-Lan Luo,Ling Lin,María F. Jiménez-Herrera. Role of Automatic Tube Compensation as Spontaneous Breathing Trial in Critically Ill Patients: A Systematic Review and Meta-Analysis. Signa Vitae. 2020. 16(2);20-28.


[1] Dettmer MR, Damuth E, Zarbiv S, et al. Prognostic Factors for Long-Term Mortality in Critically Ill Patients Treated With Prolonged Mechanical Ventilation: A Systematic Review. Critical care medicine. 2017;45:69-74.

[2] Palkar A, Mayo P, Singh K, et al. Serial Diaphragm Ultrasonography to Predict Successful Discontinuation of Mechanical Ventilation. Lung. 2018;196:363-368.

[3] Burns KEA, Raptis S, Nisenbaum R, et al. International Practice Variation in Weaning Critically Ill Adults from Invasive Mechanical Ventilation. Annals of the American Thoracic Society. 2018;15:494-502.

[4] Deab SA, Bellani G. Extubation failure after successful spontaneous breathing trial: prediction is still a challenge! Respiratory care. 2014;59:301-302.

[5] Georgakas I, Boutou AK, Pitsiou G, et al. Central Venous Oxygen Saturation as a Predictor of a Successful Spontaneous Breathing Trial from Mechanical Ventilation: A Prospective, Nested Case-Control Study. The open respiratory medicine journal. 2018;12:11-20.

[6] Chittawatanarat K, Orrapin S, Jitkaroon K, et al. An Open Label Randomized Controlled Trial to Compare Low Level Pressure Support and T-piece as Strategies for Discontinuation of Mechanical Ventilation in a General Surgical Intensive Care Unit. Medical archives (Sarajevo, Bosnia and Herzegovina). 2018;72:51-57.

[7] Guérin C, Terzi N, Mezidi M, et al. Low-pressure support vs automatic tube compensation during spontaneous breathing trial for weaning. Annals of intensive care. 2019;9:137.

[8] Lago AF, Goncalves EC, Silva EC, et al. Comparison of Energy Expenditure and Oxygen Consumption of Spontaneous Breathing Trial Conducted With and Without Automatic Tube Compensation. Journal of clinical medicine research. 2015;7:700-705.

[9] Haberthür C, Mols G, Elsasser S, et al. Extubation after breathing trials with automatic tube compensation, T-tube, or pressure support ventilation. Acta anaesthesiologica Scandinavica. 2002;46:973-979.

[10] Kashefi P, Abbasi SA, Katiraei F, et al. Comparison of the Weaning Rate in Three Mechanical Ventilation Methods, Automatic Tube Compensation and Pressure Support Ventilation with Airway Pressure of Five and Eight Centimeters of Water. اصفهان. پزشکی دانشکده مجله 2017;34:1297-1303.

[11] Wafy S, El-Shahat H, Salama S, et al. Automatic Tube Compensation Versus Pressure Support Ventilation as a Weaning Mode, Does It Make a Difference? CHEST Journal. 2015;148:312A.

[12] Burns KEA, Soliman I, Adhikari NKJ, et al. Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis. Critical Care. 2017;21:127.

[13] Schmidt GA, Girard TD, Kress JP, et al. Liberation From Mechanical Ventilation in Critically Ill Adults: Executive Summary of an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline. Chest. 2017;151:160-165.

[14] Aggarwal AN, Agarwal R, Gupta D. Automatic tube compensation as an adjunct for weaning in patients with severe neuroparalytic snake envenomation requiring mechanical ventilation: a pilot randomized study. Respiratory care. 2009;54:1697-1702.

[15] Elbatanouny M, Abdelbary AM. Use of automatic tube compensation (ATC) for weaning from mechanical ventilation in acute respiratory fail-ure. Egyptian Journal of Chest Diseases and Tuberculosis. 2017;66:699-701.

[16] Selek Ç, Özcan PE, Orhun G, et al. The Comparison of Automatic Tube Compensation (ATC) and T-piece During Weaning. Turkish journal of anaesthesiology and reanimation. 2014;42:91-95.

[17] Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from org/handbook.

[18] Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clinical research ed). 2009;339:b2535.

[19] Li Y, Li H, Zhang D. Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis. Critical care (London, England). 2020;24:67.

[20] Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collabora-tion’s tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed). 2011;343:d5928-d5928.

[21] Olivo SA, Macedo LG, Gadotti IC, et al. Scales to assess the quality of randomized controlled trials: a systematic review. Physical therapy. 2008;88:156-175.

[22] Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed). 1997;315:629-634.

[23] Cohen J, Shapiro M, Grozovski E, et al. Prediction of extubation outcome: a randomised, controlled trial with automatic tube compensation vs. pres-sure support ventilation. Critical care (London, England). 2009;13:R21.

[24] Cohen JD, Shapiro M, Grozovski E, et al. Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure. Critical care medicine. 2006;34:682-686.

[25] El-Beleidy AS, Khattab AA, El-Sherbini SA, et al. Automatic Tube Compensation versus Pressure Support Ventilation and Extubation Outcome in Children: A Randomized Controlled Study. ISRN pediatrics. 2013;2013:871376.

[26] Fayed AM, El-Feky IL. Adding automatic tube compensation to continuous positive airway pressure in weaning patients with chronic obstructive pulmonary disease, is it worth trying? Critical care medicine. 2008;36:A137.

[27] Figueroa-Casas JB, Montoya R, Arzabala A, et al. Comparison between automatic tube compensation and continuous positive airway pressure during spontaneous breathing trials. Respiratory care. 2010;55:549-554.

[28] Liang CY, Chen CW, Lin WJ. A prospective, randomized comparison of automated tube compensation (ATC) and T-piece in the weaning of mechanically ventilated patients. Am J Respir Crit Care Med. 2006;173:A41.

[29] Sherif AA, Atalaah HA. Prediction of weaning outcome, feasibility of automatic tube compensation (ATC) for weaning of chronic obstructive pulmonary disease (COPD) patients from mechanical ventilation. Anes-thesia & Analgesia. 2013;116:108.

[30] Burns KE, Lellouche F, Lessard MR, et al. Automated weaning and spontaneous breathing trial systems versus non-automated weaning strategies for discontinuation time in invasively ventilated postoperative adults. Cochrane Database Syst Rev. 2014;2014:Cd008639.

[31] Ladeira MT, Vital FM, Andriolo RB, et al. Pressure support versus T-tube for weaning from mechanical ventilation in adults. Cochrane Database Syst Rev. 2014;2014:Cd006056.

[32] Eskandar N, Apostolakos MJ. Weaning from Mechanical Ventilation. Critical Care Clinics. 2007;23:263-274.

[33] Karaca I, Comert A, Kuntman A, et al. Does automatic tube compensation change metabolic parameters when added to pressure support mode during weaning? Intensive Care Medicine Experimental. 2015;3:A321.

[34] Kuhlen R, Max M, Dembinski R, et al. Breathing pattern and workload during automatic tube compensation, pressure support and T-piece trials in weaning patients. Eur J Anaesthesiol. 2003;20:10-16.

[35] Selek Ç, Özcan PE, Orhun G, et al. The Comparison of Automatic Tube Compensation (ATC) and T-piece During Weaning. Turk J Anaesthesiol Reanim. 2014;42:91-95.

[36] Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033-1056.

[37] Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335:1864-1869.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time