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Comment & Response
November 5, 2019

Spontaneous Breathing Trials and Successful Extubation

Author Affiliations
  • 1Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
JAMA. 2019;322(17):1716. doi:10.1001/jama.2019.14217

To the Editor The results of the randomized clinical trial reported by Dr Subirà and colleagues compared a less demanding spontaneous breathing trial (SBT) of 30 minutes of pressure support ventilation (PSV) with a more demanding 2-hour T-piece SBT and showed a higher successful extubation rate favoring the less demanding test without a higher need for reintubation.1 In this trial, clinicians, who were not blinded to treatment assignment, made greater use of prophylactic respiratory interventions in the PSV group (24.7%) (8.9% noninvasive ventilation [NIV] + 15.8% high-flow nasal cannula [HFNC]) compared with the T-piece group (18.7%) (5.9% NIV + 12.8% HFNC). This analysis is limited to prophylactic use and not total use of NIV and HFNC after extubation. Moreover, it assumes that individual patients were treated prophylactically with either NIV or HFNC but not both.