Ventilation Basics

Spontaneous breathing trials (SBTs) may shorten time on mechanical ventilation and improve outcomes.([FOOTNOTE=Luetz A, Goldmann A, Weber-Carstens S, Spies C. Weaning from mechanical ventilation and sedation. Curr Opin Anaesthesiol. 2012;25(2):164-169.],[ANCHOR=],[LINK=])^,([FOOTNOTE=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.],[ANCHOR=],[LINK=])^,([FOOTNOTE=Fuchs EM, Von Rueden K. Sedation management in the mechanically ventilated critically ill patient. AACN Adv Crit Care. 2008;19(4):421-432],[ANCHOR=],[LINK=])^,([FOOTNOTE=McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med. 2012;367(23):2233-2239.],[ANCHOR=],[LINK=])^,([FOOTNOTE=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.],[ANCHOR=],[LINK=]) They can help you to predict whether your patients are ready to breathe on their own.⁵  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.^1,2

In an SBT, a safety screening first ensures that your patient is ready for a breathing trial that day.^1,2  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.^1,2  Monitor respiration, oxygen saturation, and mental and cardiac status closely.^1,2  If your patient shows no significant signs of distress after a predefined period, the test is usually considered successful and extubation may be considered.^1,2  If the patient shows signs of difficulty, additional ventilatory support may be resumed.^1,2

Ideally the SBT is done while your patient is awake and not under sedation.([FOOTNOTE=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.],[ANCHOR=],[LINK=]) There is evidence that patients who are given sedation holidays prior to SBT are more likely to pass the breathing trial.^1,2  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.^1,2

Together with sedation holidays, spontaneous breathing trials may help you to ensure safe, early liberation from mechanical ventilation and better outcomes for your patients.^1,2,6  The resources below provide more information, and can help you design a program that meets the needs of your patients and caregivers.