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Weaning from Mechanical Ventilation


Tuesday, October 26, 2004

12:30 PM- 2:00 PM

How Frequently Do We Perform Spontaneous Breathing Trials (SBT) and Rapid Shallow Breathing (RSBI) Maneuvers In Our Ventilated Patients?

Jose L. Mendez, MD*, Sujay Bangarulingam, MD, Jeffrey T. Rabatin, MD, Saqib I. Dara, MD and Bekele Afessa, MD

Mayo Clinic College of Medicine, Rochester, MN

PURPOSE: To assess the frequency and impact of daily assessment of spontaneous breathing maneuvers during mechanical ventilation.

METHODS: This prospective, observational study included 134 patients treated in the medical intensive care unit. We collected data on consecutively admitted patients who required mechanical ventilation (MV), including demographics, reason for ICU admission, duration of mechanical ventilation, weaning assessment using rapid shallow breathing index (RSBI), spontaneous breathing trial (SBT), ICU and hospital mortality. Continuous variables were expressed as mean with standard deviation (SD) or median with interquartile range (IQR).

RESULTS: Patient mean (SD) age was 61.3 (19.4) years; 94% were Caucasian and 62% were male. The most common reasons for ICU admission were pneumonia (24) and COPD exacerbation (8). The median (IQR) duration of mechanical ventilation was 3.4 (2.0 –10.4) days. Weaning assessment with RSBI was performed in 43% and SBT was performed in 31% of the patients. The median (IQR) duration of mechanical ventilation in patients who had a SBT was 3.9 (2.8 –12.1) days compared to 2.8 (1.6 –4.8) days in patients who did not have a SBT (P = 0.0609). Patients who had RSBI received mechanical ventilation for a median (IQR) of 3.8 (2.1 –11.7) days compared to 3.3 (1.8 –7.3) days for those who did not have a RSBI (P = 0.5697).

CONCLUSION: Despite studies showing decreased length of MV associated with a daily weaning assessment and SBT, only a minority of patients receiving invasive mechanical ventilation had a SBT or a RSBI maneuver performed during mechanical ventilation.

CLINICAL IMPLICATIONS: Intensivists need to improve their weaning practice based on the available evidence.

DISCLOSURE: J.L. Mendez, None.






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Copyright © 2004 by the American College of Chest Physicians.