TIRBO #45: SBT failure phenotypes

In this episode of Critical Care Scenarios, Brandon and Brian discuss spontaneous breathing trials (SBTs) for intubated patients, emphasizing that SBTs are the best approach to assess extubation readiness. They describe three phenotypes of SBT failure: rapid shallow breathing (often due to lung issues), tachypnea with adequate volumes (usually from agitation or delirium), and hypoventilation (typically caused by over-sedation). They highlight the importance of recognizing these failure modes to optimize patient management, suggesting interventions like adjusting sedation levels or addressing underlying lung conditions. The hosts also address hypoventilation or apnea at the start of the trial due to prior hyperventilation on controlled modes, recommending adjustments to ventilator settings. They conclude that many SBT failures result from over-sedation or delirium, underscoring the need to maintain a balance that allows for successful extubation.