initiate SBT when ventilator is at lowest setting

When on PRVC, lowest setting means 40% FiO2 or less, PEEP < 8. SBT means PS 5/5.1

Spontaneous breathing trials should be initiated in patients as soon as they are beginning to show lung recovery. Reasonable algorithms have protocolized spontaneous breathing trials to when patients reach a level of respiratory support that can be comfortably delivered without an endotracheal tube. Often, this is when the patient is receiving FiO2 around 50% and <10 cm H2O of PEEP. With increasing frequency in today’s practice of performing extubation directly to noninvasive ventilation or high-flow nasal cannula oxygen, these criteria may be too conservative, and patients receiving more respiratory support than FiO2 of 0.5 and 10 cm H2O of PEEP may be able to be adequately supported without mechanical ventilation. Regardless, waiting for additional lung recovery beyond FiO2 of 0.5 and 8 cm H2O of PEEP to initiate spontaneous breathing trials will only prolong the time the patient spends receiving mechanical ventilation and delay successful extubation.231

Footnotes

  1. Brochard L, Rauss A, Benito S, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med. 1994;150(4):896-903. PubMed ↩ ↩2

  2. SEEK Questionnaires ↩

  3. Shehabi Y, Howe BD, Bellomo R, et al; ANZICS Clinical Trials Group and the SPICE III Investigators. Early sedation with dexmedetomidine in critically ill patients. N Engl J Med. 2019;380(26):2506-2517. PubMed ↩