Spontaneous breathing trials

Esteban A, Alia I, Gordo F, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1997 156(2 pt 1) 459 5. 

If yes, start spontaneous breathing trial with artificial nose or CPAP 5 C111H2O or PSV 7 cmH20. Question 3... 

Abbreviations VRU, ventilator rehabilitation unit PEEP, positive end-expiratory pressure Sao2, oxygen saturation SBT, spontaneous breathing trial Fio2, fraction of inspired oxygen CHE, congestive heart failure. 

We use a defined set of weaning predictors (22-24) as a readiness assessment tool prior to a spontaneous breathing trial (SBT). During the SBT, a nurse or RT remains at the bedside for at least five minutes to coach the patient and monitor tolerance, recognizing that patients may require several minutes to adjust to a decrease in pressure support (25). 

Surfactant aerosol also has been tested in chronic bronchitis the modest improvement in FEV1 was small, and its expense would not justify use based on these data [175]. In tests of aerosol surfactant in adults with CF treated over 5 days, no improvement was found [176]. Although instilled surfactant has become common practice for the neonatal respiratory distress of premature infants, aerosol delivery is not yet adequately developed. A recent study showed no difference in outcome for spontaneously breathing newborns who inhaled either surfactant or placebo via a CPAP mask [177]. There continues to be great appeal for the use of surfactant in adults because of the apparent success in neonates, but its use should not become practice until well-controlled trials document clinically meaningful efficacy. 

Approximately, 10-20% of patients who tolerate a trial of spontaneous breathing and undergo extubation require reintubation in the subsequent 48 to 72 hours (64). Reintubated patients suffer adverse outcomes when compared to patients who tolerate extubation. In a medical ICU, reintubated patients spent 12 additional days on MV (65). Reintubated patients are also more likely to undergo tracheostomy and be transferred to a long-term care facility. 

Ferrer M, Valencia M, Nicolas JM, et al. Early noninvasive ventilation averts extubation failure in patients at risk a randomized trial. Am J Respir Crit Cate Med 2006 173 164-170. Ezingeard E, Diconne E, Guyomarch S, et al. Weaning fiom mechanical ventilation with pressure support in patients failing a T-tube trail of spontaneous breathing. Intensive Care Med 2006 32 165-169. 

Ely EW, Baker AM, Dunagan DP, et al. Effect of the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996 335 1864-1869. Kollef MH, Shapiro SD, Silver P, et al. A randomized controlled trial of protocol-directed versus physician directed weaning from mechanical ventilation. Crit Care Med 1997 25 567-574. Saura P, Blanch L, Mestre L, et al. Clinical consequences of the implementation of a weaning protocol. Intensive Care Med 1996 22 1052-1056. 

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