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Spontaneous breathing trials and ventilator adjustments

Why

Spontaneous breathing trials (SBTs) may shorten time on mechanical ventilation and improve outcomes.2-6 They can help you to predict whether your patients are ready to breathe on their own.6 In conjunction with good sedation management, SBTs can help return your patients to unsupported breathing sooner, potentially reducing the risks and discomfort of prolonged mechanical ventilation.2,3

How

In an SBT, a safety screening first ensures that your patient is ready for a breathing trial that day.2,3 If he or she passes the screen, you may consider adjusting the ventilator to provide no or reduced breathing support (less than 7 cmH2O inspiratory pressure), for example, via pressure support, continuous positive airway pressure (CPAP) or ventilation with a T-piece.2-3 Monitor respiration, oxygen saturation, and mental and cardiac status closely.2,3 If your patient shows no significant signs of distress after a predefined period, the

test is usually considered successful and extubation may be considered.2,3 If the patient shows signs of difficulty, additional ventilatory support may be resumed.2,3

Ideally the SBT is done while your patient is awake and not under sedation.7 There is evidence that patients who are given sedation holidays prior to SBT are more likely to pass the breathing trial.2,3 Those patients may also leave the ICU sooner and show lower mortality one year later, compared to controls who had daily SBTs without daily sedation breaks.2,3

Together with sedation holidays, spontaneous breathing trials may help you to ensure safe, early liberation from mechanical ventilation and better outcomes for your patients.2,3,7 The resources below provide more information, and can help you design a program that meets the needs of your patients and caregivers.

  1. Epstein SK. How often does patient-ventilator asynchrony occur and what are the consequences? Respir Care. 2011;56(1):25-38.

  2. Luetz A, Goldmann A, Weber-Carstens S, Spies C. Weaning from mechanical ventilation and sedation. Curr Opin Anaesthesiol. 2012;25(2):164-169.

  3. Hooper MH, Girard TD. Sedation and weaning from mechanical ventilation: Linking spontaneous awakening trials and spontaneous breathing trials to improve patient outcomes. Anesthesiol Clin. 2011;29(4):651-661.

  4. Fuchs EM, Von Rueden K. Sedation management in the mechanically ventilated critically ill patient. AACN Adv Crit Care. 2008;19(4):421-432

  5. McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med. 2012;367(23):2233-2239.

  6. Chawla S, Natarajan G, Gelmini M, Kazzi SN. Role of spontaneous breathing trial in predicting successful extubation in premature infants. Pediatr Pulmonol. 2013;48(5):443-438.

  7. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008;371(9607):126-134.