Author/Authors :
Godard, Stephanie University of Ottawa Medical School, Ottawa, Canada , Herry, Christophe Ottawa Hospital Research Institute, Ottawa, Canada , Westergaard, Paul The Ottawa Hospital - University of Ottawa, Ottawa, Canada , Scales, Nathan Ottawa Hospital Research Institute, Ottawa, Canada , Brown, Samuel M. Intermountain Medical Center - University of Utah, Murray, USA , Burns, Karen St. Michael’s Hospital - University of Toronto, Toronto, Canada , Mehta, Sangeeta Mount Sinai Hospital - University of Toronto, Toronto, Canada , Jacono, Frank J. University Hospitals Case Medical Center and Louis Stokes Cleveland VA Medical Centre - Case Western Reserve University, Cleveland, USA , Kubelik, Dalibor The Ottawa Hospital - University of Ottawa, Ottawa, Canada , Maziak, Donna E. The Ottawa Hospital - University of Ottawa, Ottawa, Canada , Marshall, John St. Michael’s Hospital - University of Toronto, Toronto, Canada , Martin, Claudio London Health Science Centre - Victoria Hospital - Western University, London, Canada , Seely, Andrew J. E. The Ottawa Hospital - University of Ottawa, Ottawa, Canada
Abstract :
Background. Spontaneous breathing trials (SBTs) are standard of care in assessing extubation readiness; however, there are no
universally accepted guidelines regarding their precise performance and reporting. Objective. To investigate variability in SBT
practice across centres. Methods. Data from 680 patients undergoing 931 SBTs from eight North American centres from theWeaning
and Variability Evaluation (WAVE) observational study were examined. SBT performance was analyzed with respect to ventilatory
support, oxygen requirements, and sedation level using the Richmond Agitation Scale Score (RASS).The incidence of use of clinical
extubation criteria and changes in physiologic parameters during an SBT were assessed. Results. The majority (80% and 78%) of
SBTs used 5 cmH2O of ventilator support, although there was variability. A significant range in oxygenation was observed. RASS
scores were variable, with RASS 0 ranging from 29% to 86% and 22% of SBTs performed in sedated patients (RASS < −2). Clinical
extubation criteria were heterogeneous among centres. On average, there was no change in physiological variables during SBTs.
Conclusion. The present study highlights variation in SBT performance and documentation across and within sites. With their
impact on the accuracy of outcome prediction, these results support efforts to further clarify and standardize optimal SBT technique.
