Give Me (Vent) Liberty or Give Me Death

In this episode of Pulmcast, Rachel and the other host discuss the important, yet sometimes difficult, decision of when to extubate a patient in the ICU. They begin with a brief history of mechanical ventilation, highlighting advances made over the centuries. The hosts then delve into the specifics of spontaneous breathing trials (SBTs), including various modes and the importance of daily trials. They explore weaning predictors like the cuff leak test, mental status, and RSBI, emphasizing the significance of RSBI in predicting successful extubation. They also discuss factors to consider beyond the numbers, such as the original reason for intubation and the patient's overall clinical course. Finally, they discuss strategies to optimize patients after extubation, including the ReConnect trial, BiPAP, and high flow nasal cannula, and address the nuances of re-intubation rates.