Sneha Patel, PharmD
Trauma Clinical Pharmacy Specialist
Ascension Saint Thomas Rutherford Hospital
Disclosure information not submitted.
Joanna Stollings, PharmD, FCCM
MICU Clinical Pharmacy Specialist
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Disclosure information not submitted.
Jonathan Casey, MD
MD
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
Todd Rice, MD, MSc,FCCM
Associate Prof. of Medicine
Vanderbilt University School of Medicine
Nashville, Tennessee, United States
Disclosure information not submitted.
Matthew Semler, MD, MSc
MD
Vanderbilt University, United States
Disclosure information not submitted.
Title: Identifying Predictors of Extubation the Day of Passing an SBT in Critically Ill Adults
Introduction: Many patients who pass a spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) do not undergo extubation that day. We aimed to identify predictors of extubation the day of passing an SBT and to develop prediction models for extubation among mechanically ventilated patients.
Methods: We performed a retrospective, observational cohort study of mechanically ventilated patients who had passed an SBT in a single, academic medical intensive care unit from 2018 to 2019 to develop a logistic regression model for identifying predictors of extubation.
Results: Of 745 patients in our study, 77% were extubated the day they passed a spontaneous breathing trial. Independent predictors of extubation included higher RASS (-2 compared to –4: OR 1.83, 95% CI 1.56 to 2.14), receipt of sedation on day prior (OR 2.12, 95% CI 1.63 to 2.74), without diagnosis of sepsis or septic shock (OR 0.77, 95% CI 0.59 to 1), without neurological illness (OR 0.59, 95% CI 0.37 to 0.96), with indication for intubation of altered mental status/seizure/agitation (OR 1.67, 95% CI 1.05 to 2.65), and without hemodynamic instability or cardiac arrest (OR 0.67, 95% CI 0.47 to 0.95).
Conclusions: Patients on mechanical ventilation were more likely to be extubated on the day they passed an SBT if they had higher RASS scores, were on sedation, or did not have diagnosis of sepsis, neurological illness, or hemodynamic instability. Future research should attempt to identify and address modifiable risk factors for failure to extubate after passing an SBT.