Extubation without a Trial of Spontaneous Ventilation in the General Surgical Population

Abstract

We hypothesized that it may not be necessary to conduct a trial of spontaneous ventilation as a prerequisite for discontinuation of mechanical ventilation in surgical intensive care unit (SICU) patients. Method: To test this hypothesis, we prospectively studied 113 SICU patients who were considered for extubation without such a trial if their SIMV rate was 4/min, their PaO₂ was ⩾ 60 torr with FIO₂ ≤ 0.40 and PEEP ≤ 5 cm H₂O, they did not need inotropic support, and they were intubated solely for ventilatory assistance. If they met those guidelines, pH and certain lung function values were measured. Those patients were then extubated who met three of the following five criteria: IF ≤ -30 cm H₂O, pH ≥ 7.30, f ≤ 30/min (including IMV breaths), VC ⩾ 10 ml/kg, and V_T ⩾ 5 ml/kg. Results: Of 120 extubation attempts, 119 were successful. Moreover, only half the patients met strict published criteria for extubation. Conclusions: Our findings indicate that a patient's failure to fulfill all conventional extubation criteria is not necessarily a contraindication to extubation, and extubation without a trial of spontaneous ventilation can be safe and effective in selected cases.