scholarly journals Practice Variation in Spontaneous Breathing Trial Performance and Reporting

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Stephanie Godard ◽  
Christophe Herry ◽  
Paul Westergaard ◽  
Nathan Scales ◽  
Samuel M. Brown ◽  
...  
Keyword(s):  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Ventilatory Support ◽  
Standard Of Care ◽  
Practice Variation ◽  
Ventilator Support ◽  
Physiological Variables ◽  
Physiologic Parameters ◽  
Spontaneous Breathing Trials ◽  
Oxygen Requirements

Background. Spontaneous breathing trials (SBTs) are standard of care in assessing extubation readiness; however, there are no universally accepted guidelines regarding their precise performance and reporting.Objective. To investigate variability in SBT practice across centres.Methods. Data from 680 patients undergoing 931 SBTs from eight North American centres from the Weaning and Variability Evaluation (WAVE) observational study were examined. SBT performance was analyzed with respect to ventilatory support, oxygen requirements, and sedation level using the Richmond Agitation Scale Score (RASS). The incidence of use of clinical extubation criteria and changes in physiologic parameters during an SBT were assessed.Results. The majority (80% and 78%) of SBTs used 5 cmH2O of ventilator support, although there was variability. A significant range in oxygenation was observed. RASS scores were variable, with RASS 0 ranging from 29% to 86% and 22% of SBTs performed in sedated patients (RASS < −2). Clinical extubation criteria were heterogeneous among centres. On average, there was no change in physiological variables during SBTs.Conclusion. The present study highlights variation in SBT performance and documentation across and within sites. With their impact on the accuracy of outcome prediction, these results support efforts to further clarify and standardize optimal SBT technique.

Direct Two-Minute Unassisted Breathing Evaluation (DTUBE) is an Attractive Alternative to Longer Spontaneous Breathing Trials: A Prospective Observational Study

2017 ◽  
Vol 83 (3) ◽  
pp. 308-313 ◽  
Author(s):  
Matthew B. Bloom ◽  
Jonathan Lu ◽  
Tri Tran ◽  
Marko Bukur ◽  
Rex Chung ◽  
...  
Keyword(s):  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Surgical Intensive Care Unit ◽  
Attractive Alternative ◽  
Surgical Intensive Care ◽  
Minute Period ◽  
Spontaneous Breathing Trials ◽  
Bedside Method ◽  
Simple Bedside ◽  
Successful Extubation

We sought to identify a simple bedside method to predict successful extubation outcomes that might be used during rounds. We hypothesized that a direct 2-minute unassisted breathing evaluation (DTUBE) could replace a longer spontaneous breathing trial (SBT). Data were pro-spectively collected on all patients endotracheally intubated for >48 hours nearing extubation in a tertiary center's mixed trauma/surgical intensive care unit from August 2012 to August 2013. The SBT was performed for at least 30 minutes at 40 per cent FiO2, PEEP 5, and PS 8. DTUBE was performed by physically disconnecting the intubated patient from the ventilator circuit for a 2-minute period of direct observation on room air. Successful extubation was defined freedom from ventilator for greater than 72 hours. Both SBTand DTUBE were performed 128 times, resulting in 90 extubations. The DTUBE correctly predicted success in 75/79 (94.9%) extubations versus 82/89 (92.1%) via SBT. No adverse effects were directly attributed to the DTUBE. The DTUBE is a rapid method of evaluating patients for extubation with prediction accuracy similar to the SBT.

Autonomic Tone in Medical Intensive Care Patients Receiving Mechanical Ventilation and During a CPAP Weaning Trial

2008 ◽  
Vol 9 (4) ◽  
pp. 301-310 ◽  
Author(s):  
Susan K. Frazier ◽  
Debra K. Moser ◽  
Rebecca Schlanger ◽  
Jeanne Widener ◽  
Lauren Pender ◽  
...  
Keyword(s):  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Ventilatory Support ◽  
Intrathoracic Pressure ◽  
Spontaneous Ventilation ◽  
Autonomic Tone ◽  
Autonomic Responses ◽  
Intensive Care Patients ◽  
Weaning Failure ◽  
Tissue Oxygen Delivery

Mechanical ventilator support and the resumption of spontaneous ventilation or weaning create significant alterations in alveolar and intrathoracic pressure that influence thoracic blood volume and flow. Compensatory autonomic tone alterations occur to ensure adequate tissue oxygen delivery, but autonomic responses may produce cardiovascular dysfunction with subsequent weaning failure. The authors describe autonomic responses of critically ill patients ( n = 43) during a 24-hr period of mechanical ventilatory support and during the 24 hr that included their initial spontaneous breathing trial using continuous positive airway pressure. Nearly two thirds of these patients demonstrated abnormal autonomic function and this dysfunction was more severe in those patients who were unable to sustain spontaneous ventilation ( n = 15). With further systematic study, autonomic responses may be useful in the identification of patients who are likely to develop cardiac dysfunction with the resumption of spontaneous breathing.

Early extubation strategy after congenital heart surgery: 1-year single-centre experience

2021 ◽  
pp. 1-7
Author(s):  
Lyudmil Simeonov ◽  
Dimitar Pechilkov ◽  
Anna Kaneva ◽  
Mary C. McLellan ◽  
Kathy Jenkins
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Hospital Length ◽  
Early Extubation ◽  
Ventilation Time ◽  
Significant Difference ◽  
Spontaneous Breathing Trials

Abstract Introduction: Our aim was to present the initial experience with a protocol-driven early extubation strategy and to identify risk factors associated with failed spontaneous breathing trials within 12 hours after surgery. Methods: A single institutional retrospective study of children up to 18 years of age was conducted in post-operative cardiac surgical patients over a 1-year period. A daily spontaneous breathing trial protocol was used to assess patients’ readiness for extubation. The study population (n = 129) was stratified into two age groups: infants (n = 84) and children (n = 45), and further stratified according to ventilation time: early extubation (ventilation time less than 12 h, n = 86) and deferred extubation (ventilation time more than 12 h, n = 43). Mann–Whitney U-test and binomial logistic regression were used for statistical analysis. Results: Early extubated infants had shorter ICU (4 versus 6 days, p = 0.003) and hospital length of stays (16 versus 19 days, p = 0.006), lower re-intubation rates (1 versus 7 patients, p = 0.003), and lower mortality (0 versus. 4 patients, p = 0.01) than deferred extubated infants. There was no significant difference in the studied outcomes in the children group. Malnourished infants and longer cardiopulmonary bypass times were independently associated with failed spontaneous breathing trials within 12 hours after cardiac surgery. Conclusions: Early extubated infants after cardiac surgery had shorter ICU and hospital length of stay, without an increase in morbidity and mortality, compared to infants who deferred extubation. Nutritional status and longer cardiopulmonary bypass times were risk factors for failed spontaneous breathing trial.

Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation

2017 ◽  
Vol 126 (6) ◽  
pp. 1107-1115 ◽  
Author(s):  
Martin Dres ◽  
Damien Roux ◽  
Tài Pham ◽  
Alexandra Beurton ◽  
Jean-Damien Ricard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pleural Effusion ◽  
Spontaneous Breathing ◽  
Odds Ratio ◽  
Spontaneous Breathing Trial ◽  
Ventilatory Support ◽  
Weaning Failure ◽  
Weaning Outcome

Abstract Background Pleural effusion is frequent in intensive care unit patients, but its impact on the outcome of weaning remains unknown. Methods In a prospective study performed in three intensive care units, pleural ultrasound was performed at the first spontaneous breathing trial to detect and quantify pleural effusion (small, moderate, and large). Weaning failure was defined by a failed spontaneous breathing trial and/or extubation requiring any form of ventilatory support within 48 h. The primary endpoint was the prevalence of pleural effusion according to weaning outcome. Results Pleural effusion was detected in 51 of 136 (37%) patients and was quantified as moderate to large in 18 (13%) patients. As compared to patients with no or small pleural effusion, their counterparts were more likely to have chronic renal failure (39 vs. 7%; P = 0.01), shock as the primary reason for admission (44 vs. 19%; P = 0.02), and a greater weight gain (+4 [0 to 7] kg vs. 0 [−1 to 5] kg; P = 0.02). The prevalence of pleural effusion was similar in weaning success and weaning failure patients (odds ratio, 1.23; 95% CI, 0.61 to 2.49; P = 0.56), as was the prevalence of moderate to large pleural effusion (odds ratio, 0.89; 95% CI, 0.33 to 2.41; P = 1.00). Duration of mechanical ventilation and intensive care unit length of stay were similar between patients with no or small pleural effusion and those with moderate to large pleural effusion. Conclusions Significant pleural effusion was observed in 13% of patients at the time of liberation from mechanical ventilation and was not associated with an alteration of weaning outcome. (Anesthesiology 2017; 126:1107–15)

How to Write Ventilator Orders

2017 ◽  
Author(s):  
John W. Kreit
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Respiratory Acidosis ◽  
Spontaneous Breathing Trials ◽  
Ventilator Settings

How to Write Ventilator Orders provides step-by-step instructions on how to write ventilator orders—how to choose appropriate settings immediately after intubation; how to adjust ventilator settings throughout the course of the patient’s illness; and when weaning the patient from mechanical ventilation—how to write orders for spontaneous breathing trials. For writing initial ventilator orders, we discuss: choosing a mode of mechanical ventilation, choosing the type of mechanical breath, selecting settings based on the type of mechanical breath, and specifying other basic settings. Next, the chapter covers recommended adjustments to settings in cases of high PaO2 and SpO2, low PaO2 andSpO2, and respiratory acidosis and alkalosis. A table at the end of the chapter shows the orders needed to perform an on-ventilator spontaneous breathing trial.

scholarly journals Pulmonary Stretch and Lung Mechanotransduction: Implications for Progression in the Fibrotic Lung

2021 ◽  
Vol 22 (12) ◽  
pp. 6443
Author(s):  
Alessandro Marchioni ◽  
Roberto Tonelli ◽  
Stefania Cerri ◽  
Ivana Castaniere ◽  
Dario Andrisani ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
Spontaneous Breathing ◽  
Elastic Limit ◽  
Physiological Stress ◽  
Fibrous Tissue ◽  
Ventilatory Support ◽  
Biological Response ◽  
Alveolar Epithelium ◽  
Strain Curve ◽  
Mechanical Forces

Lung fibrosis results from the synergic interplay between regenerative deficits of the alveolar epithelium and dysregulated mechanisms of repair in response to alveolar and vascular damage, which is followed by progressive fibroblast and myofibroblast proliferation and excessive deposition of the extracellular matrix. The increased parenchymal stiffness of fibrotic lungs significantly affects respiratory mechanics, making the lung more fragile and prone to non-physiological stress during spontaneous breathing and mechanical ventilation. Given their parenchymal inhomogeneity, fibrotic lungs may display an anisotropic response to mechanical stresses with different regional deformations (micro-strain). This behavior is not described by the standard stress–strain curve but follows the mechano-elastic models of “squishy balls”, where the elastic limit can be reached due to the excessive deformation of parenchymal areas with normal elasticity that are surrounded by inelastic fibrous tissue or collapsed induration areas, which tend to protrude outside the fibrous ring. Increasing evidence has shown that non-physiological mechanical forces applied to fibrotic lungs with associated abnormal mechanotransduction could favor the progression of pulmonary fibrosis. With this review, we aim to summarize the state of the art on the relation between mechanical forces acting on the lung and biological response in pulmonary fibrosis, with a focus on the progression of damage in the fibrotic lung during spontaneous breathing and assisted ventilatory support.

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