Role of a successful spontaneous breathing trial in ventilator liberation in brain-injured patients

Zhong-Hua Shi, Annemijn H Jonkman, Pieter Roel Tuinman, Guang-Qiang Chen, Ming Xu, Yan-Lin Yang, Leo M A Heunks, Jian-Xin Zhou

Research output: Contribution to journalArticleAcademicpeer-review


Background: Spontaneous breathing trials (SBTs) have been shown to improve outcomes in critically ill patients. However, in patients with brain injury, indications for intubation and mechanical ventilation are different from those of non-neurological patients, and the role of an SBT in patients with brain injury is less established. The aim of the present study was to compare key respiratory variables acquired during a successful SBT between patients with successful ventilator liberation versus failed ventilator liberation.

Methods: In this prospective study, patients with brain injury (≥18 years of age), who completed a 30-min SBT, were enrolled. Airway pressure, flow, esophageal pressure, and diaphragm electrical activity (ΔEAdi) were recorded before (baseline) and during the SBT. Respiratory rate (RR), tidal volume, inspiratory muscle pressure (ΔPmus), ΔEAdi, and neuromechanical efficiency (ΔPmus/ΔEAdi) of the diaphragm were calculated breath by breath and compared between the liberation success and failure groups. Failed liberation was defined as the need for invasive ventilator assistance within 48 h after the SBT.

Results: In total, 46 patients (51.9±13.2 years, 67.4% male) completed the SBT. Seventeen (37%) patients failed ventilator liberation within 48 h. Another 11 patients required invasive ventilation within 7 days after completing the SBT. There were no differences in baseline characteristics between the success and failed groups. In-depth analysis showed similar changes in patterns and values of respiratory physiological parameters between the groups.

Conclusions: In patients with brain injury, ventilator liberation failure was common after successful SBT. In-depth physiological analysis during the SBT did not provide data to predict successful liberation in these patients.

Trial registration: The trial was registered at (No. NCT02863237).

Original languageEnglish
Pages (from-to)548
JournalAnnals of Translational Medicine
Issue number7
Publication statusPublished - Apr 2021

Cite this