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spontaneous breathing trial (SBT)

also see ventilation weaning Indications: - identify patients for endotracheal extubation Procedure: 1) patient is placed on a T-tube - no positive pressure - positive pressure (8-cm H2O) may afford a less taxing breathing trial [3] - supplemental oxygen provided - trial of 30 minutes to 2 hours [1] 2) low-level pressure support ventilation - 8 cm H2O without positive end-expiratory pressure - advantage of monitoring tidal volume & respiratory rate [4] * no difference between 2 methods in reintubation or ventilator-free days [4] Clinical significance: - success if: - ability to tolerate spontaneous breathing trial for 30 minutes - respiratory rate < 35/min - SaO2 > 90% without arrhythmia, sudden tachycardia, changesin blood pressure, respiratory distress, diaphoresis, or anxiety

Related

ventilation weaning

General

clinical procedure

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2022.
  2. Loinc
  3. Subira C, Hernandez G, Vazquez A 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; 321:2175. PMID: 31184740 https://jamanetwork.com/journals/jama/fullarticle/2735502 - Girard TD, Burns KEA. Revisiting, reframing, and casting a new light on liberation from mechanical ventilation. JAMA 2019 Jun 11; 321:2167. PMID: 31184723 https://jamanetwork.com/journals/jama/fullarticle/2735481
  4. Thille AW et al. Spontaneous-breathing trials with pressure-support ventilation or a T-piece. N Engl J Med 2022 Nov 17; 387:1843-1854. PMID: 36286317 https://www.nejm.org/doi/10.1056/NEJMoa2209041