Spontaneous breathing trial needs to be prolonged in critically ill and older patients requiring mechanical ventilation

PurposeTo investigate a modified weaning procedure to predict extubation outcome in critically older and ventilated patients.MethodsWe 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 (T0) (periods I and II), 2 and 8 (T8) hours after SBT (period II).ResultsThe 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 T8. The ratio of RSBI at T8 over T0 (T8/T0 ≤ 1.4) demonstrated good diagnostic value (sensitivity 89.5%, specificity 80.0%, accuracy 88.4%) in predicting successful extubation.ConclusionsFor 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.