Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation

Publication Date: March 5, 2024
Last Updated: March 7, 2024

Summary of Recommendations

We suggest that an RSBI is not needed to determine readiness for an SBT. (C, M )
620
We suggest that SBTs can be conducted with or without low-level PSV (# 8 cm H2O). (C, M )
620
We suggest a standardized approach to assessment and, if appropriate, completion of an SBT before noon each day. (C, VL )
620
We suggest that FIO2 should not be increased during an SBT. (C, VL )
620

Recommendation Grading

Abbreviations

  • PSV: Pressure Support Ventilation
  • RSBI: Rapid Shallow Breathing Index
  • SBT: Spontaneous Breathing Trial

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation

Authoring Organization

Publication Month/Year

March 5, 2024

Last Updated Month/Year

March 13, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

Despite prior publications of clinical practice guidelines related to ventilator liberation, some questions remain unanswered. Many of these questions relate to the details of bedside implementation. We, therefore, formed a guidelines committee of individuals with experience and knowledge of ventilator liberation as well as a medical librarian. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, we make the following recommendations: (1) We suggest that calculation of a rapid shallow breathing index is not needed to determine readiness for a spontaneous breathing trial (SBT) (conditional; moderate certainty); (2) We suggest that SBTs can be conducted with or without pressure support ventilation (conditional recommendation, moderate certainty); (3) We suggest a standardized approach to assessment and, if appropriate, completion of an SBT before noon each day (conditional recommendation, very low certainty); and (4) We suggest that FIO2 should not be increased during an SBT (conditional recommendation, very low certainty). These recommendations are intended to assist bedside clinicians to liberate adult critically ill patients more rapidly from mechanical ventilation.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant, respiratory therapist

Scope

Management

Diseases/Conditions (MeSH)

D012122 - Ventilators, Mechanical, D014691 - Ventilation, D015300 - Ventilator Weaning

Keywords

mechanical ventilation, extubation, weaning, liberation, spontaneous breathing trials

Source Citation

Roberts KJ, Goodfellow LT, Battey-Muse CM, Hoerr CA, Carreon ML, Sorg ME, Glogowski J, Girard TD, MacIntyre NR, Hess DR. AARC Clinical Practice Guideline: Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation. Respir Care. 2024 Mar 5:respcare.11735. doi: 10.4187/respcare.11735. Epub ahead of print. PMID: 38443142.