Gordo et al., "Extubation outcome after spontaneous breathing trials
with T-tube or pressure support ventilation," American Journal of Respiratory Critical Care Medicine, vol.
This improved compliance with nurse-driven sedation vacation, but not physician-driven peptic ulcer disease prophylaxis or respiratory therapist-driven spontaneous breathing trials
Hypercapnic ventilatory response has been studied in spontaneous breathing trials
and extubation , duration of weaning , central sleep apnea , and relatives of patients with obesity hypoventilation syndrome .
Previous studies have shown several factors to predict extubation failure, including the rapid shallow breathing index (14), positive fluid balance in previous 24 hours (4), pneumonia as the reason for initiating mechanical ventilation (4), amount of endotracheal secretions (15-18), mental status (18) and hypercapnia (4,18) during the spontaneous breathing trial
. Although this was not the aim of our study, we found only pneumonia to be an independent risk factor for RRS.
Exclusion criteria were non-septic patients, septic patients using any vasopressor other than noradrenaline, ratio of respiratory rate to tidal volume (f/[V.sub.T]) [greater than or equal to] 105 or maximal inspiratory pressure (MIP) [greater than or equal to]-30 [cmH.sub.2]O, and failure to tolerate a spontaneous breathing trial
(SBT) (Figure 1).
Inclusion criteria included extubated patients older than age 65 years, intubated for COPD or CHF for 48 hours or more, with a successful spontaneous breathing trial
In this case report we present three COPD patients with repeated spontaneous breathing trial
failures, who were successfully extubated after receiving sildenafil.
Whether or not one believes that gradual weaning is needed after a failed spontaneous breathing trial
, a judgment regarding the patient's readiness to breathe spontaneously still must be made.
The title is: "Multicenter implementation of a consensus-developed, evidence-based, spontaneous breathing trial
protocol." This article appeared in the October issue of Critical Care Medicine 2008; Volume 36 (Number 10): pages 2753-2762.