Comparison of Spontaneous Breathing Trials in Clinical Practice and Current Clinical Practice Guidelines

Abstract

Background: Literature suggests there is variability in the clinical practice of spontaneous breathing trials (SBTs). Evidence-based literature and clinical practice guidelines (CPGs) have been published over time to address various aspects of SBT implementation. It can take many years for evidence-based literature to be adopted into clinical practice. The American Association of Respiratory Care (AARC) recently published CPGs addressing 4 aspects of SBT implementation. This study evaluated how the clinical practice of SBTs compares to the recommendations of the CPGs.

Methods: An online survey was developed to assess how hospitals with SBT protocols perform different components of SBTs. This study received IRB exemption. The published survey was posted on AARC Connect and the National Alliance of Respiratory Care Professionals LinkedIn page. A hospital with a formal protocol for an SBT in adult mechanically ventilated patients was the inclusion criteria for survey participation. Descriptive statistics were used in the data analysis.

Results: A total of 26 representatives from different healthcare institutions in the United States met the criteria for data analysis. 61.5% of reported protocols use RSBI, which is not in alignment with the current recommendation. 77% reported the use of pressure support (PS), 11.5% specified the use of a T-piece, and 11% specified the option of either PS or T-piece during the SBT. The responses are 100% in alignment with the current recommendation of performing a SBT with or without support. 73.1% align with having a standardized approach to performing SBTs by specifying when the SBT will be initiated. 65.4% perform an SBT during the day, though it is not specified if it occurs before noon each day. 53.8% allow for an increase in FIO₂ during an SBT, which is not in alignment with the current recommendations.

Conclusions: The reported hospitals’ protocols demonstrated moderate alignment with the 4 CPGs’ recommendations. Identifying current discrepancies between clinical practice and CPGs will allow the adoption of CPG recommendations into clinical practice to be assessed over time. Further assessment could be performed to determine if there is an impact on patient outcomes.