Critical Care Scenarios Episode 95: Spontaneous breathing trials with Martin Tobin
Oct 29, 2025
Dr. Martin Tobin, a renowned pulmonologist and author of influential texts on mechanical ventilation, shares his expertise on spontaneous breathing trials (SBTs). He highlights the shift from prolonged weaning to brief trials and critiques common practices that misinterpret patient readiness. Tobin emphasizes practical SBT methods, like T-piece tests, and instructs on recognizing work of breathing without invasive tools. He discusses the importance of timely extubation and shares insights on managing sedation and respiratory drive during trials for optimal patient outcomes.
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SBT Is A Predictive Test Not Gradual Weaning
- A spontaneous breathing trial (SBT) exists solely to forecast whether a patient will tolerate extubation.
- Perform an SBT to predict extubatability, not as gradual 'weaning.'
Don't Use PS 5/PEEP 5 As Default SBT
- Avoid using pressure support of ~5 cmH2O plus PEEP as your default SBT because it reduces work of breathing by ~40%.
- Use minimal or no ventilator assistance to avoid falsely reassuring SBT results.
Simulate Post-Extubation With T-Piece Or PS0/CPAP0
- Run SBTs on a T-piece or ventilator set to zero support (PS 0/CPAP 0) to simulate post-extubation conditions.
- Prefer T-piece for research cleanliness but PS 0/CPAP 0 is clinically acceptable.
