Requirements

1. reverse of acute process
2. Appropriate LOC
3. Appropriate strength of cough/gag
4. Overall good strength “can you lift up your head?”

<aside> 💡

Goal if any ICU unit should be a failure rate of around 15%! This helps to dial in how intently to extubate a patient

</aside>

Spontaneous breathing trial (SBT)

• Vent Settings

  • Most strenuous/intense: 0/0 on the vent. Continuous circuit monitoring. Extra resistance with the vent. Physiologically, this is the most physiologic representation of how they will breathe after extubation. Not good if someone is obese/
  • T piece. Keep pt connected to vent, but there is another outlet for breathing

  

  • Most common: 5/5. Probably the same as T piece physiologically

• 90 min to 2 hours on this

• Rapid shallow breathing index (RSBI) = RR/Vt

  • Predicts failure of SBT well

• Why do pts fail SBT:

  • Apnea
  • Distress
  • HD instability
  • Desaturation
  • Most common reason: cardiogenic pulmonary edema (LV likes +ve pressure into the thorax). If this happens, consider additional diuresis. This is ~80% of the number of SVTs
  • Delirium
  • Agitation
  • Pure muscle weakness (rare)