Table 3 Type of assessment and criteria for performing a spontaneous breathing test
Clinical assessment | Improvement of acute process (ARDS and associated conditions) leading to intubation and mechanical ventilation |
|---|---|
Patient is alert and cooperative | |
Chest pain is controlled | |
Adequate cough (moderate to high strength) | |
Absence of excessive tracheobronchial secretion | |
No signs of respiratory distress: | |
Nostril flaring | |
Use of accessory muscles of respiration (suprasternal and/or intercostal retraction) | |
Paradoxical movements of the chest/abdomen | |
Objective measurements | Respiratory stability: oxygenation |
PEEP ≤10 cmH2O | |
Support pressure ≤10 cmH2O | |
PaO2/FiO2 ≥250 (consider weaning if ≥150) | |
SpO2 > 90% under FiO2 ≤40% | |
Respiratory stability: function | |
Respiratory rate ≤35 breaths/min | |
Minute volume < 10 L/min | |
Respiratory rate/tidal volume (L) < 105 breath/min/L | |
No significant respiratory acidosis (pH ≥7.25) | |
Cardiovascular stability | |
Heart rate <140 bpm | |
Systolic blood pressure > 90 and <160 mmHg | |
Without vasoconstrictor/inotropic drugs (or low doses) | |
Neurological stability | |
Patient alert and cooperative - SAS 4 (acceptable: slightly drowsy patient (SAS 3) slightly agitated (SAS 5)) |