Following the theme of some recent posts on
Status Iatrogenicus (
here and
here) about testing and treatment thresholds, one of our stellar fellows Meghan Cirulis MD and I wrote a letter to the editor of JAMA about the
recent article by Subira et al comparing shorter duration Pressure Support Ventilation to longer duration T-piece trials. Despite adhering to my well hewn formula for letters to the editor, it was not accepted, so as is my custom, I will publish it here.
Spoiler alert - when the patients you enroll in your weaning trial have a base rate of extubation success of 93%, you should not be doing an SBT - you should be extubating them all, and figuring out why your enrollment criteria are too stringent and how many extubatable patients your enrollment criteria are missing because of low sensitivity and high specificity.
