TABLE 2.
Clinical guidelines and weaning predictors for discontinuing IMV before and during SBT.
| Measurements/Predictors | Parameters before and during SBT |
| Consciousness state | GCS >12 points, awake and alert |
| Hemodynamic stability | Low doses of 1 or 2 vasoactive drugs, no myocardial ischemia, HR <130 bpm, no hypotension |
| Respiratory stability | Spontaneous breathing, FiO2 <60%; SpO2 >90% and no use of accessory muscles |
| Rapid Shallow Breathing Index (RSBI) | <60–105 breaths/min/L |
| Negative Inspiratory Force (NIF) | −20 to −30 cmH2O during SBT |
| Integrated Pulmonary Index (IPI) | >8 points |
| Effective cough | Peak Expiratory Flow (PFE) >−60 L/min |
| Type of Spontaneous Breathing Trial (SBT) | Avoid T-piece and PEEP/PS 0,0 cmH2O |
| PEEP | >5 cmH2O, preferably 8 cmH2O during SBT |
| Pressure Support (PS) | <8 cmH2O during SBT |
| Diaphragmatic excursion (diEx) | >1.8 cm during SBT |
| Diaphragmatic Thickening Fraction (diThF%) | 30–36% during SBT Note: Difficulty in obtaining measurements may be encountered in this population |
SBT, Spontaneous breathing trail; GCS, Glasgow Coma Scale; HR, heart rate; FiO2, fraction of inspired oxygen; RSBI, Rapid Shallow Breathing Index; NIF, Negative Inspiratory Force; diEx, diaphragmatic excursion; diThF, diaphragmatic thickening fraction.