spontaneous breathing trial (SBT)
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Introduction
also see ventilation weaning
Indications
- identify patients for endotracheal extubation
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
Procedure
- patient is placed on a T-tube
- no positive pressure
- supplemental oxygen provided
- trial of 30 minutes to 2 hours[1]
- 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]
* pressure support & more frequent trials increases time to success[5]
* a daily trial without pressure support recommended[5]
Management
- early extubation to noninvasive ventilation in patients with COPD, heart failure, or hypercarbia[1]
- BiPAP useful for apnea during weaning trials related to obesity hypoventilation syndrome
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2022.
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Loinc
- ↑ 3.0 3.1 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: https://pubmed.ncbi.nlm.nih.gov/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: https://pubmed.ncbi.nlm.nih.gov/31184723 https://jamanetwork.com/journals/jama/fullarticle/2735481 - ↑ 4.0 4.1 4.2 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: https://pubmed.ncbi.nlm.nih.gov/36286317 https://www.nejm.org/doi/10.1056/NEJMoa2209041
- ↑ 5.0 5.1 5.2 Ippolito M, Sardo S, Tripodi VF et al. Association between spontaneous breathing trial methods and reintubation in adult critically ill patients: A systematic review and network meta-analysis of randomized controlled trials. Chest 2024 Nov 15; 166:1020. PMID: https://pubmed.ncbi.nlm.nih.gov/38964674 https://journal.chestnet.org/article/S0012-3692(24)04575-6/abstract
Burns KEA, Wong J, Rizvi L et al. Frequency of screening and spontaneous breathing trial techniques: A randomized clinical trial. JAMA 2024 Dec 3; 332:1808-2021 PMID: https://pubmed.ncbi.nlm.nih.gov/39382222 Clinical Trial. https://jamanetwork.com/journals/jama/fullarticle/2824928