ISSN: 2577-4301
Authors: Rose L , Burns KEA , Dodek P , Mallick R , Fergusson D , Cook DJ , Burry LD , Meade M and Mehta S
Rationale: Spontaneous breathing trials (SBT) allow evaluation of a patient’s potential to breathe independently, but do not directly assess extubation readiness. Objectives: To describe adherence to SBT screening and conduct, and extubation rates after successful SBTs in patients enrolled in a multicenter randomized trial comparing protocolized sedation with protocolized sedation plus daily sedation interruption. Methods: We recruited 430 critically ill, mechanically ventilated adults from 16 North American ICUs. In both study groups, patients were screened daily using standardized criteria to undergo an SBT; eligible patients underwent a 60- minute SBT. If SBT was successful, respiratory therapists notified the clinical ICU team responsible for extubation decisions. If not performed, or no extubation despite passing an SBT, respiratory therapists documented 1 of 8 reasons. Measurements and Main Results: SBT screening occurred on 92% and 93% days in the interruption and control groups, respectively. Among screened patients, interruption group was eligible for an SBT less often than controls (32% versus 36% days, P=0.003). In both groups, SBTs were performed on 82% of days SBTs were indicated. Despite successful SBT, extubation did not occur on 61% (interruption) and 65% (control) of days (P=0.24). Reasons for no extubation on the day of a successful SBT differed between groups; however the most common reasons in both groups were concerns about consciousness level and physician request. Conclusion: Mechanically ventilated patients were extubated less than 40% of the time on the day of a successful SBT. The patterns, predictors and outcomes associated with delayed extubation warrant further evaluation. ClinicalTrials.gov NCT 00675363.
Keywords: Spontaneous breathing trial; Extubation; Mechanical ventilation; Sedation
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