Spontaneous Breathing Trials in Patients Managed with a Sedation Protocol or a Sedation Protocol with Daily Interruption

Rationale: Spontaneous breathing trials (SBT) allow evaluation of a patient's potential to breathe independently, but do not directly assess extubation readiness. Objectives: To describe adherence to SBT screening and conduct, and extubation rates after successful SBTs in patients enrolled in a multicenter randomized trial comparing protocolize d sedation with protocolize d sedation plus daily sedation interruption.Methods: We recruited 430 critically ill, mechanically ventilated adults from 16 North American ICUs. In both study groups, patients were screened daily using standardized criteria to undergo an SBT; eligible patients underwent a 60 - minute SBT. If SBT was successful, respiratory therapists notified the clinical ICU team responsible for extubation decisions. If not performed, or no extubation despite passing an SBT, respirat ory therapists documented 1 of 8 reasons. Measurements and Main Results: SBT screening occur red on 92% and 93% days in the interruption and control groups, respectively. Among screened patients, interruption group was eligible for an SBT less often than controls (32% versus 36% days, P=0.003). In both groups, SBTs were performed on 82% of days SB Ts were indicated. Despite successful SBT, extubation did not occur on 61% (interruption) and 65% (control) of days (P=0.24). Reasons for no extubation on the day of a successful SBT differed between groups; however the most common reasons in both groups w ere concerns about consciousness level and physician request. Conclusion: Mechanically ventilated patients were extubated less than 40% of the time on the day of a successful SBT. The patterns, predictors and outcomes associated with d elayed extubation wa rrant further evaluation. ClinicalTrials.gov NCT 00675363 .