Short (30 Minutes) versus long (120 Minutes) spontaneous breathing trial among patients with difficult weaning (SL-SBT Trial)

•Difficult weaning is common in the ICU and is associated with increased consumption of hospital resources and worse outcome. Protocolized weaning in this setting might improve patient-centred outcomes.•An SBT duration of either 30 min or 120 min is equally effective when used for the first weaning attempt. However, the optimal duration of SBT for patients who failed the first attempt is not known.•SL-SBT trial compared 30 min and 120 min of SBT using pressure support of 6 cm of H2O for difficult-to-wean patients and showed that the success rate of extubation is similar with both approaches. The optimal duration of spontaneous breath trial (SBT) for patients with difficult extubation from mechanical ventilation is unknown. This study compared extubation success with two different durations of SBT in patients who failed their first SBT. This single-center randomized controlled trial included adults on mechanical ventilation who had failed their first SBT. The participants were randomized to receive pressure support ventilation (PSV) for either 30 or 120 min. Our primary outcome was the rate of successful extubation (without reintubation within 48 h). Key secondary outcomes were the length of intensive care unit (ICU) and hospital stay and in-hospital and 90-day mortality. A total of 119 patients (62.2 % male) with a mean age of 53.9 years were randomized to undergo SBT for either 30 min (n = 60) or 120 min (n = 59). Among them, 82.4 % of patients had hypercapnic respiratory failure. The rates of successful extubation were similar with SBT of 30 min and 120 min (58.3 % vs. 59.3 %, respectively; p = 0.91). There were no significant differences between the two groups in terms of the durations of ICU and hospital stay or in-hospital and 90-day mortality. Extubation success and other clinically important outcomes were comparable between short (30 min) and long (120 min) SBT in difficult weaning. A 30-minute SBT may be acceptable in this setting.