**[Spontaneous Breathing trial Protocol]{.underline}**

1.  Introduction:

> Although mechanical ventilation is a lifesaving procedure, it carries
> numerous life threatening complications. Therefore it is important to
> discontinue mechanical ventilation at the earliest possible time.
> Clinical decision to discontinue mechanical ventilation is often
> arbitrary, and relies heavily on the practitioner experience. Recent
> published literature has shown that daily screening of respiratory
> function of patients receiving mechanical ventilation, followed by
> spontaneous breathing trials, resulted in reduction in the duration of
> mechanical ventilation and lower cost of intensive care in addition to
> fewer complications. Therefore we propose this following spontaneous
> breathing trial Protocol for all adult patients receiving mechanical
> ventilation.

2.  Collaborators: Said Soubra, MD

> Venkata Bandi, MD
>
> Marcia Katz, MD
>
> Harish Seethamraju, MD

3.  Refereces:

1\. E. Wesley Ely. Effect of the duration of mechanical ventilation of
identifying patients capable of breathing spontaneously. NEJM
1996;335:1864-9

2\. Andres Esteban. A comparison of four methods of weaning patients
from mechanical ventilation. NEJM 1995; 3321:345-350

3\. Neil MacIntyre. Evidence Based guidelines for weaning and
discontinuing ventilatory support. Chest 2001; 120:375S-395S

4\. Jonathan Cohen. Automatic tube compensation-assisted respiratory
rate to tidal volume ratio improves the prediction of weaning outcome.
Chest 2002; 122:980

5\. Yugi Fujino. Spontaneously breathing lung model comparison of work
of breathing between ATC and pressure support. Respir care 2003; 48(1):
38-45

6\. Andres Esteban. Extubation outcome after spontaneous breathing
trials with T-tube or pressure support ventilation. Am J Respir Crit
Care Med 1997; 156:459-65

**[Spontaneous Breathing Trial]{.underline}**

> [Assessment for extubation]{.underline}
>
> ***Check if the following criteria are met***
>
> O Evidence of reversal of the underlying cause of respiratory failure
>
> O Adequate oxygenation (e.g. PaO~2~/FiO~2~ \>150-200; FIO~2~\<40-50%;
> PEEP\<5-8)
>
> O Hemodynamic stability
>
> O Capability to initiate an inspiratory effort
>
> O Adequate mentation
>
> ***if above criteria are met***

# Ask Respiratory Therapy to Measure the Following Parameters

> Maximal Inspiratory Pressure ( - 20cm H~2~O)
>
> Respiratory Rate (35 breaths/min)
>
> Tidal Volume ( 5 ml/kg)
>
> Rapid Shallow breathing index RR/TV ( 105)
>
> ***if above criteria are met***

## Ask Respiratory Therapy to start Spontaneous breathing Trial 

> Choose one of the following modalities:
>
> O T piece trial; FiO~2~ of \-\-\--%
>
> O Pressure Support PS \-\-\-- cm H2O(5-8 cm H2O); PEEP 5 cm H~2~O,
> FiO~2~ \-\-\--%
>
> O Automatic Tube Compensation 100%; FiO~2~ \-\-\--%
>
> Continue SBT for 30 minutes

## Assessment of Tolerance

O Respiratory Rate \< 35 breaths/min

O SaO~2~ \> 90% on FiO~2~ \<0.4-0.5

O Heart Rate \< 120% from baseline

O Systolic Blood Pressure

O Absence of respiratory distress (use of accessory muscles, abdominal
paradox..)

O Optional ABG criteria: Increase in PaCO2 \<10 mm Hg or Decrease pH \<
0.1

> ***if above criteria are met* Call MD for extubation**

if above criteria are not met resume previous ventilator orders and
inform MD of results of SBT