title: Spontaneous breathing trial needs to be prolonged in critically ill and older patients requiring mechanical ventilation.
abstract: OBJECTIVE
  To investigate a modified weaning procedure to predict extubation outcome in critically older and ventilated patients.
  
  
  METHODS
  We retrospectively analyzed extubation outcome in older (≥ 70 years) and ventilated patients. In period I (2007), patients passing a 2-hour spontaneous breathing trial (SBT) were extubated. In period II (2008), patients underwent an 8-hour SBT on day 1 and a 2-hour SBT, followed by extubation on day 2. Weaning parameters were recorded at baseline (T(0)) (periods I and II), 2 and 8 (T(8)) hours after SBT (period II).
  
  
  RESULTS
  The demographic data of patients in each period (n = 64 and 67, respectively) were similar. Patients in period II demonstrated a higher rate of SBT failure but a significantly lower rate of extubation failure and reintubation mortality. In period II, successfully extubated patients demonstrated a significantly lower value of rapid shallow breathing index (RSBI) at T(8). The ratio of RSBI at T(8) over T(0) (T(8)/T(0) ≤ 1.4) demonstrated good diagnostic value (sensitivity 89.5%, specificity 80.0%, accuracy 88.4%) in predicting successful extubation.
  
  
  CONCLUSIONS
  For critically older and ventilated patients, a prolonged SBT in conjunction with evolution of the RSBI ratio over baseline during SBT may serve as a useful procedure to predict extubation outcome.
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, 112 Taiwan.
authors.forename: Kang-Cheng
authors.initials: KC
authors.lastname: Su
authors.forename: Cheng-Chien
authors.initials: CC
authors.lastname: Tsai
authors.forename: Kun-Ta
authors.initials: KT
authors.lastname: Chou
authors.forename: Chong-Chen
authors.initials: CC
authors.lastname: Lu
authors.forename: Yung-Yang
authors.initials: YY
authors.lastname: Liu
authors.forename: Chun-Sheng
authors.initials: CS
authors.lastname: Chen
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Wu
authors.forename: Yu-Chin
authors.initials: YC
authors.lastname: Lee
authors.forename: Diahn-Warng
authors.initials: DW
authors.lastname: Perng
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation; D000465:Algorithms; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013624:Taiwan; D015300:Ventilator Weaning