🫁 Spontaneous Breathing Trial Screening (SBT Readiness)
Spontaneous breathing trial (SBT) readiness and interpretation for liberation from mechanical ventilation.
Clinical takeaway
Daily readiness screening plus an SBT shortens ventilation duration compared with gradual weaning (original synthesis · not guideline verbatim).
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When to use
Use to check readiness criteria before an SBT and to interpret pass/fail to guide extubation.
How it works
Assess readiness (resolving cause, adequate oxygenation on low support, hemodynamic stability, intact airway protection); perform SBT 30–120 min on minimal support or T-piece; pass → consider extubation; fail → resume support and address the cause.
Key points
- Daily readiness screening plus an SBT shortens ventilation duration compared with gradual weaning (original synthesis · not guideline verbatim).
- Pair the SBT with a spontaneous awakening trial (sedation interruption) for the greatest benefit.
- A passed SBT does not guarantee extubation success — also assess airway patency (cuff leak) and secretion burden.
References
- Girard TD, et al. ABC trial (awakening + breathing). Lancet 2008.
- ATS/ACCP liberation guidelines. Am J Respir Crit Care Med 2017.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Cause of respiratory failure improved/controlled | No |
|---|---|
| Adequate oxygenation (PaO₂/FiO₂ ≥ 150, FiO₂ ≤ 0.5, PEEP ≤ 5–8, SpO₂ ≥ 90%) | No |
| Hemodynamically stable (no/low-dose vasopressors, no active myocardial ischemia) | No |
| pH ≥ 7.25 | No |
| Can trigger spontaneous breaths, arousable | No |
→SBT readinessNot met
- Determination：Not met: cause not controlled, oxygenation not adequate, hemodynamically unstable, pH < 7.25, no spontaneous breathing/not arousable
- Management direction：Continue optimizing (treat the primary disease, adjust sedation/volume/internal milieu), re-screen after correction; can pair with a daily spontaneous awakening trial (SAT)
- Note：SBT readiness is the first step in weaning: cause improved + adequate oxygenation + hemodynamic stability + pH ≥ 7.25 + able to breathe spontaneously. Passing an SBT is key evidence for extubation, but airway protection (cough strength, secretions, airway patency) must also be assessed
| Cause of respiratory failure improved/controlled | Yes |
|---|---|
| Adequate oxygenation (PaO₂/FiO₂ ≥ 150, FiO₂ ≤ 0.5, PEEP ≤ 5–8, SpO₂ ≥ 90%) | Yes |
| Hemodynamically stable (no/low-dose vasopressors, no active myocardial ischemia) | Yes |
| pH ≥ 7.25 | Yes |
| Can trigger spontaneous breaths, arousable | Yes |
→SBT readinessMet (SBT can proceed)
- Determination：All readiness criteria met → may start a spontaneous breathing trial
- Management direction：Perform SBT: low support (PSV 5–8/PEEP ≤ 5 or T-piece) for 30–120 min; pass criteria = tolerance, RR < 35, SpO₂ ≥ 90%, no distress/diaphoresis/arrhythmia or hemodynamic deterioration; may combine with RSBI < 105. If passed with good airway protection and manageable secretions → extubate
- Note：SBT readiness is the first step in weaning: cause improved + adequate oxygenation + hemodynamic stability + pH ≥ 7.25 + able to breathe spontaneously. Passing an SBT is key evidence for extubation, but airway protection (cough strength, secretions, airway patency) must also be assessed
Frequently asked questions
- What is Spontaneous Breathing Trial Screening (SBT Readiness)?
- Spontaneous breathing trial (SBT) readiness and interpretation for liberation from mechanical ventilation.
- How is Spontaneous Breathing Trial Screening (SBT Readiness) calculated? What is the core formula?
- Assess readiness (resolving cause, adequate oxygenation on low support, hemodynamic stability, intact airway protection); perform SBT 30–120 min on minimal support or T-piece; pass → consider extubation; fail → resume support and address the cause.
- When is Spontaneous Breathing Trial Screening (SBT Readiness) used?
- Use to check readiness criteria before an SBT and to interpret pass/fail to guide extubation.
- What are the key clinical points for Spontaneous Breathing Trial Screening (SBT Readiness)?
- Daily readiness screening plus an SBT shortens ventilation duration compared with gradual weaning (original synthesis · not guideline verbatim). Pair the SBT with a spontaneous awakening trial (sedation interruption) for the greatest benefit. A passed SBT does not guarantee extubation success — also assess airway patency (cuff leak) and secretion burden.
- What are the limits and cautions when using Spontaneous Breathing Trial Screening (SBT Readiness)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Spontaneous Breathing Trial Screening (SBT Readiness) calculated in practice? Can you show a worked example?
- Inputs: Cause of respiratory failure improved/controlled No, Adequate oxygenation (PaO₂/FiO₂ ≥ 150, FiO₂ ≤ 0.5, PEEP ≤ 5–8, SpO₂ ≥ 90%) No, Hemodynamically stable (no/low-dose vasopressors, no active myocardial ischemia) No, pH ≥ 7.25 No, Can trigger spontaneous breaths, arousable No → Result: SBT readiness Not met（Determination: Not met: cause not controlled, oxygenation not adequate, hemodynamically unstable, pH < 7.25, no spontaneous breathing/not arousable, Management direction: Continue optimizing (treat the primary disease, adjust sedation/volume/internal milieu), re-screen after correction; can pair with a daily spontaneous awakening trial (SAT), Note: SBT readiness is the first step in weaning: cause improved + adequate oxygenation + hemodynamic stability + pH ≥ 7.25 + able to breathe spontaneously. Passing an SBT is key evidence for extubation, but airway protection (cough strength, secretions, airway patency) must also be assessed） Inputs: Cause of respiratory failure improved/controlled Yes, Adequate oxygenation (PaO₂/FiO₂ ≥ 150, FiO₂ ≤ 0.5, PEEP ≤ 5–8, SpO₂ ≥ 90%) Yes, Hemodynamically stable (no/low-dose vasopressors, no active myocardial ischemia) Yes, pH ≥ 7.25 Yes, Can trigger spontaneous breaths, arousable Yes → Result: SBT readiness Met (SBT can proceed)（Determination: All readiness criteria met → may start a spontaneous breathing trial, Management direction: Perform SBT: low support (PSV 5–8/PEEP ≤ 5 or T-piece) for 30–120 min; pass criteria = tolerance, RR < 35, SpO₂ ≥ 90%, no distress/diaphoresis/arrhythmia or hemodynamic deterioration; may combine with RSBI < 105. If passed with good airway protection and manageable secretions → extubate, Note: SBT readiness is the first step in weaning: cause improved + adequate oxygenation + hemodynamic stability + pH ≥ 7.25 + able to breathe spontaneously. Passing an SBT is key evidence for extubation, but airway protection (cough strength, secretions, airway patency) must also be assessed）