Dr Sarang Patil


Ÿ Discontinuation of invasive mechanical ventilation
consists of 2 phases: weaning (abolishing the need for
ventilatory support) and extubation (removal of the
endotracheal tube [ETT] when it is no longer required).1
Extubation is a commonly performed procedure in ICUs.
Ÿ Weaning from MV accounts for up to 40% of time spent on
MV and an SBT constitutes the gold standard diagnostic
test to determine a patients' readiness for extubation
Ÿ Currently used SBT modalities include methods that
provide ventilatory support, such as pressure support
ventilation (5-8 cm H2O with or without PEEP), CPAP or
automatic tube compensation; and methods without any
ventilatory support, such as T-piece
Ÿ Decades of research have been dedicated to finding the
optimal protocolized SBT modality that best simulates
physiologic conditions post-extubation, in order to infer a
patients' readiness to liberate from MV
Ÿ Recent meta-analyses and guidance have been
inconclusive or contradicting
Ÿ Studies have shown that different SBT modalities and
duration demonstrate no significant difference regarding
success rate of extubation (PSV vs. T-piece for 2h, 30-
minute vs. 2h PSV or 30-minute vs. 2h T-piece). The optimal
SBT modality and duration to ascertain a patients'
readiness to be extubated remains unknown

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OSA in obese patients S.Patil CHEST volume 155, Issue 6 Page A383


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