title: Practice Variation in Spontaneous Breathing Trial Performance and Reporting.
abstract: Background. Spontaneous breathing trials (SBTs) are standard of care in assessing extubation readiness; however, there are no universally accepted guidelines regarding their precise performance and reporting. Objective. To investigate variability in SBT practice across centres. Methods. Data from 680 patients undergoing 931 SBTs from eight North American centres from the Weaning and Variability Evaluation (WAVE) observational study were examined. SBT performance was analyzed with respect to ventilatory support, oxygen requirements, and sedation level using the Richmond Agitation Scale Score (RASS). The incidence of use of clinical extubation criteria and changes in physiologic parameters during an SBT were assessed. Results. The majority (80% and 78%) of SBTs used 5 cmH2O of ventilator support, although there was variability. A significant range in oxygenation was observed. RASS scores were variable, with RASS 0 ranging from 29% to 86% and 22% of SBTs performed in sedated patients (RASS < -2). Clinical extubation criteria were heterogeneous among centres. On average, there was no change in physiological variables during SBTs. Conclusion. The present study highlights variation in SBT performance and documentation across and within sites. With their impact on the accuracy of outcome prediction, these results support efforts to further clarify and standardize optimal SBT technique.
authors.affiliation: University of Ottawa Medical School, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Godard
authors.affiliation: Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON, Canada K1Y 4E9.
authors.forename: Christophe
authors.initials: C
authors.lastname: Herry
authors.affiliation: The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6.
authors.forename: Paul
authors.initials: P
authors.lastname: Westergaard
authors.affiliation: Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON, Canada K1Y 4E9.
authors.forename: Nathan
authors.initials: N
authors.lastname: Scales
authors.affiliation: Intermountain Medical Center, University of Utah, 5121 Cottonwood Street, Murray, UT 84157, USA.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Brown
authors.affiliation: St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, Canada M5B 1W8.
authors.forename: Karen
authors.initials: K
authors.lastname: Burns
authors.affiliation: Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, Canada M5G 1X5.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.affiliation: University Hospitals Case Medical Center and Louis Stokes Cleveland VA Medical Centre, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Jacono
authors.affiliation: The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6.
authors.forename: Dalibor
authors.initials: D
authors.lastname: Kubelik
authors.affiliation: The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6.
authors.forename: Donna E
authors.initials: DE
authors.lastname: Maziak
authors.affiliation: St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, Canada M5B 1W8.
authors.forename: John
authors.initials: J
authors.lastname: Marshall
authors.affiliation: London Health Science Centre, Victoria Hospital, Western University, 800 Commissioners Road E., London, ON, Canada N6A 4G5.
authors.forename: Claudio
authors.initials: C
authors.lastname: Martin
authors.affiliation: The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6.
authors.forename: Andrew J E
authors.initials: AJ
authors.lastname: Seely
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation; D002170:Canada; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D014481:United States; D015300:Ventilator Weaning / Q000379:methods*; D055815:Young Adult