Clinical criteria used to determine readiness for trials of spontaneous breathing

Required criteria

The cause of the respiratory failure has improved

PaO₂/FiO₂ ≥150* or SpO₂ ≥90% on FiO₂ ≤40% and PEEP ≤5 cmH₂O

pH >7.25

Hemodynamic stability (no or low dose vasopressor medications)

Able to initiate an inspiratory effort

Additional criteria (optional criteria)

Hemoglobin ≥7 g/dL

Core temperature ≤38 to 38.5°C

Mental status awake and alert or easily arousable

PaO₂: arterial oxygen tension; FiO₂: fraction of inspired oxygen; SpO₂: arterial oxygen saturation; PEEP: positive end-expiratory pressure.

* A threshold of PaO₂/FiO₂ ≥120 can be used for patients with chronic hypoxemia. Some patients require higher levels of PEEP to avoid atelectasis during mechanical ventilation.

Adapted from: MacIntyre NR, Cook DJ, Ely EW Jr, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001; 120:375S.

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Clinical criteria used to determine readiness for trials of spontaneous breathing