Percentage of Reintubation in Patients with T-Piece Spontaneous Breathing Trial
The percentage of reintubation in patients undergoing a T-piece spontaneous breathing trial (SBT) ranges from 10-20%, with most recent evidence showing approximately 13.6-17.5% of patients requiring reintubation after a successful T-piece SBT. 1, 2, 3
Reintubation Rates by SBT Method
T-Piece SBT Reintubation Rates
- 10-20% reintubation rate according to clinical guidelines 1
- 13.6% reintubation rate in high-risk patients (recent multicenter trial) 2
- 17.5% reintubation rate in a prospective observational study 3
- Historically, 30-40% of patients who fail an SBT may need reintubation 1
Comparative Reintubation Rates
- T-piece SBT: 13.6% vs. Pressure Support Ventilation (PSV) SBT: 14.9% (difference not statistically significant) 2
- T-piece SBT: 17.5% vs. Zero Pressure Support SBT: 14.6% (difference not statistically significant) 3
- T-piece SBT: 11.9% vs. PSV SBT: 11.1% (difference not statistically significant) 4
Factors Affecting Reintubation Rates
Patient-Related Risk Factors
- Ineffective cough
- Excessive tracheobronchial secretions
- Swallowing disorders
- Altered consciousness
- Advanced age (>65 years)
- Underlying chronic cardiac or respiratory disease 1, 2
SBT Protocol Considerations
- Duration of SBT (30 minutes to 2 hours)
- Method of SBT (T-piece vs. pressure-augmented)
- Previous duration of mechanical ventilation
- Patient population (respiratory failure, cardiac failure, post-surgical) 1
Clinical Implications
Extubation Success Rates
- Despite successful SBTs, extubation failure occurs in 10-20% of cases 1
- T-piece SBTs are more demanding and result in lower extubation success rates (74.0%) compared to PSV SBTs (82.3%) 4
- The ICU clinician should aim for an extubation failure rate between 5-10%, which is considered potentially acceptable 1
Optimizing SBT Protocols
- Conducting SBTs with pressure augmentation (5-8 cmH₂O) is more likely to be successful (84.6% vs. 76.7%) and produces higher rates of extubation success (75.4% vs. 68.9%) compared to T-piece trials 1
- Recent evidence suggests high-flow oxygen SBTs may be associated with lower reintubation risk compared to T-piece SBTs 5
Pitfalls and Caveats
- SBT success alone does not guarantee extubation success, as it does not predict consequences of endotracheal tube removal (upper-airways obstruction, lack of airway protection, cough efficiency) 1
- Unplanned extubations without SBT assessment have higher reintubation rates (40-60%) 1
- A cuff leak test should be performed before extubation to predict laryngeal edema, especially in patients with risk factors for inspiratory stridor 1
- The SBT method selection should consider the patient's underlying condition and risk factors for extubation failure 1, 6
T-piece SBT remains a commonly used method for assessing readiness for extubation, but clinicians should be aware of the significant reintubation risk and consider additional assessment methods to identify patients at higher risk of extubation failure.