Friday January 18, 2008
Revisiting Weaning ! - parameters to watch in SBT

Dr. Neil MacIntyre in his recent editorial (Critical Care Medicine) 1, simply put the following 7 measurements to watch in SBT (spontaneous Breathing Trial) beside RSBI - rapid shallow breathing index - f/VT.

Objective measurements

1. Gas exchange acceptability

• Spo2 ≥85-90%,
• Po2 ≥50-60 torr,
• pH ≥7.32,
• increase in Paco2 of ≤10 torr

2. Hemodynamic stability

• heart rate <120-140>
• heart rate not changed by >20%,
• systolic blood pressure <180-200>90,
• blood pressure not changed by >20%,
• no pressors required

3. Stable ventilatory pattern e.g.,

• respiratory rate ≤30-35 breaths/min,
• respiratory rate not changed by >50%

Subjective clinical assessments

• No change in mental status (e.g., somnolence, coma, agitation, anxiety)
• No onset or worsening of discomfort
• No diaphoresis
• No signs of increased work of breathing (use of accessory respiratory muscles, thoracoabdominal paradox)

* Editorial is written in respone to article in same issue from Tobin and Jubran: Meta-analysis under the spotlight: Focused on a meta-analysis of ventilator weaning 2.



References: click to get article

1. Ventilator discontinuation process: Evidence and guidelines , Critical Care Medicine:Volume 36(1)January 2008pp 329-330

2. Meta-analysis under the spotlight: Focused on a meta-analysis of ventilator weaning , Critical Care Medicine. 36(1):1-7, January 2008. Tobin, Martin J. MD; Jubran, Amal MD