SBT Pass Extubation Decision — FRCA Final MCQ

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EasyIntensive Care MedicineSBT Pass Extubation DecisionFRCA Final

A 60-year-old man in ICU with ARDS on day 7 shows improving oxygenation. He is on FiO2 0.35, PEEP 8, VT 420 mL, RR 16. An SBT on PS 5/PEEP 5 for 30 minutes shows: RR 18, VT 450 mL, HR 82, SpO2 96%, no distress. RSBI = 40. What is the next step?

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Correct answer: E — Increase sedation and rest overnight

This patient has passed the SBT comprehensively: RSBI 40 (<105), stable vital signs, no distress, adequate gas exchange. The next step is EXTUBATION. Before extubation: assess cough strength and volume of secretions (ability to clear secretions), ensure the patient can protect the airway, check cuff leak (especially if prolonged intubation), and have reintubation equipment immediately available. Post-extubation: supplemental oxygen, monitoring, and consider HFNO or NIV for patients at high risk of re-intubation. This patient's RSBI of 40 predicts successful extubation with high confidence.

Reference: ICS – 2023 – Weaning and extubation guidelines; Boles JM et al – 2007 – Weaning from mechanical ventilation