Godard Stephanie, Herry Christophe, Westergaard Paul, Scales Nathan, Brown Samuel M, Burns Karen, Mehta Sangeeta, Jacono Frank J, Kubelik Dalibor, Maziak Donna E, Marshall John, Martin Claudio, Seely Andrew J E
University of Ottawa Medical School, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5.
Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON, Canada K1Y 4E9.
Can Respir J. 2016;2016:9848942. doi: 10.1155/2016/9848942. Epub 2016 Mar 29.
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.
背景。自主呼吸试验（SBTs）是评估拔管准备情况的护理标准；然而，关于其具体实施和报告，尚无普遍接受的指南。目的。调查各中心SBT实践的变异性。方法。对来自北美八个中心的断奶与变异性评估（WAVE）观察性研究中680例接受931次SBT的患者的数据进行了检查。使用里士满躁动量表评分（RASS）分析SBT在通气支持、氧气需求和镇静水平方面的表现。评估了临床拔管标准的使用发生率以及SBT期间生理参数的变化。结果。大多数（80%和78%）的SBT使用5cmH2O的通气支持，尽管存在变异性。观察到氧合有显著范围。RASS评分各不相同，RASS为0的范围从29%到86%，22%的SBT是在镇静患者（RASS < -2）中进行的。各中心的临床拔管标准存在差异。平均而言，SBT期间生理变量没有变化。结论。本研究强调了各中心之间以及各中心内部SBT实施和记录的变异性。鉴于其对结果预测准确性的影响，这些结果支持进一步明确和规范最佳SBT技术的努力。
