A 70-year-old woman is intubated in the ICU for respiratory failure following an episode of aspiration with resulting pneumonitis.
Which of the following practices is most likely to decrease her duration of mechanical ventilation?A. Spontaneous breathing trial performed when supervised by the attending physician
Correct Answer: B
Routine, protocolized implementation of a spontaneous breathing trial, paired with a spontaneous awakening trial, or interruption of sedation, results in a decreased duration of mechanical ventilation when compared with spontaneous breathing trial alone. Spontaneous breathing trials should be performed as a routine practice based on protocol, rather than when directed only by a medical provider (answers A and E are incorrect). Studies examining early tracheostomy have not demonstrated a decreased time on the ventilator, though this approach may be appropriate in select cases when reversal of the underlying process is not expected within several weeks (answer D is incorrect). In comparison with a decremental pressure support-based ventilator liberation strategy, spontaneous breathing trial is superior in ability to decrease the duration of mechanical ventilation (answer C is incorrect).