Real-World Data: Exploring Spontaneous Breathing Trials and Extubation

Real-world data are increasingly used to evaluate the effectiveness of treatments and interventions in everyday clinical settings. While extensive evidence exists on mechanical ventilation, there is limited research on the temporal relationship between spontaneous breathing trials (SBTs) and successful extubation, or the extent to which providers incorporate SBT data into patient care decisions.

The study goals were to compare unit SBT and extubation rates and time intervals at two time points and explore providers' extubation practices and use of SBT data.

A sequential mixed-methods approach (retrospective chart reviews, interviews) was used to examine SBT and extubation times across five intensive care units (ICUs) at a Level I trauma centre during two time periods. Interviews were conducted with healthcare providers involved with SBT and/or extubation to gain a fuller understanding of clinical practices and the use of SBT data. Statistical and qualitative analysis procedures were performed. A grounded theory-informed approach was used for qualitative analysis, allowing key themes around extubation decision-making to emerge inductively. Content analysis was also employed to systematically organise responses, resulting in an integrated interpretation across both data types.

Quantitative analysis revealed significant variation in extubation outcomes across units and over time with the time from SBT to extubation increasing significantly from 2020 to 2023 (p < 0.01). Multivariable models identified unit-level factors and year of extubation as significant predictors of timing and success. Using 2020 as the reference year, successful extubation was significantly more likely in 2023 for Unit C (OR = 1.56, 95% CI: 1.24-1.98, p < 0.001) and overall (OR = 1.22, 95% CI: 1.08-1.38, p < 0.001). No significant association was observed for Units A, B, D or E (OR range: 1.05-1.14; p = 0.38-0.86). Six themes and subthemes were identified regarding the use of SBTs and the differences in the quantitative data.

Time intervals between SBT and extubation increased significantly from 2020 to 2023, indicating that timing of extubation was influenced not only by patient readiness but also by staffing patterns, workflow dynamics and professional culture. The variability observed across units and over time reflects changes in practice, likely driven by the pandemic, highlighting the need for adaptable, resilient frameworks that support continuity or resumption of best practices even amid crisis or transition.

This study underscores the role of unit-level practices related to Table 2 SBTs and extubation. Qualitative data indicate that unit-based variations were influenced by team collaboration, staff experience and expertise and patient status. These findings highlight the need to balance adherence to weaning protocols with clinical judgement, patient factors and safety. By leveraging real-world data to examine the factors that influence SBT and extubation practices, critical care nurses can take an evidence-based approach to improve provider and unit practices, standardise and tailor patient care and mitigate provider distress regarding perceived inconsistencies in patient care. Using a data-driven strategy promotes effective resource allocation by optimising staffing, equipment and clinical interventions with patient needs and acuity.