Episode 95: Spontaneous breathing trials with Martin Tobin

This episode of Critical Care Scenarios features a discussion on spontaneous breathing trials (SBT) with Dr. Martin Tobin, an expert in mechanical ventilation. The hosts, Brandon Odo and Brian Bolling, along with Dr. Tobin, delve into the purpose of SBTs, the optimal methods for conducting them, and common misconceptions in critical care practice. Dr. Tobin argues against using pressure support or CPAP during SBTs, advocating for T-piece trials or zero over zero settings to accurately assess a patient's readiness for extubation. The conversation covers the duration of trials, criteria for determining success, and the role of the Rapid Shallow Breathing Index. Dr. Tobin emphasizes the importance of meticulous physical examination over reliance on ventilator parameters and challenges the notion of routine "weaning," highlighting the need to minimize ventilator use and avoid over-sedation. The discussion also addresses post-extubation management, including the cautious use of non-invasive support and high-flow nasal cannula, and the importance of closely monitoring oxygen saturation.