A decision to extubate can be made at any point during the SBT. The person starting the SBT should indicate how long they wish the patient to remain on the test before they want to make a decision to extubate or not. The SBT can be as little as 5-10 minutes but must not continue longer than 2 hours.
If the patient shows signs of respiratory distress they are not tolerating the SBT. Seek help from senior staff immediately to review the patients ventilation requirements. The patient may not need to go back to their pre-SBT ventilation settings, they may only need a slight increase in pressure from the SBT settings. In this instance the patient is still progressing towards extubation.
There may be legitimate reasons why a patient may not progress to extubation following a successful SBT. Please use the key to classify appropriate causes of delayed extubation.
Considering why the patient has not tolerated the SBT is vital to guide clinicians as to how to progress. Ask yourself ‘did the patient become distressed due to increased work of breathing’ or ‘did the patient become apnoeic’? This will indicate if the patient needs to go back on a mandatory rate, but does not require higher pressures. Alternatively this may indicate a patient can tolerate the spontaneous mode but still needs increased pressure support to maintain adequate respiration.
As with the bedside screen, please do not delay! Inform senior staff your patient has tolerated their SBT at the earlier opportunity to allow extubation as soon as possible.
When senior staff discuss their rationale for decision making with junior staff they are drip feeding theoretical knowledge and developing awareness of the multiple factors impacting on a decision to extubate.
The Wellcome-Wolfson Institute for Experimental Medicine
School of Medicine, Dentistry and Biomedical Sciences
Queen's University Belfast
97 Lisburn Road
Tel: (+44) 028 9097 1643