Spontaneous Breathing Trial Checklist

Clinical-use note: This checklist supports a protocolized workflow; it does not determine candidacy, define universal stop thresholds, or replace bedside judgment, local policy, and the treating team. Stop the trial and restore appropriate support whenever continuing appears unsafe.

1

Before the trial

Readiness screen

Use a simple, standardized screen. Exact oxygenation and hemodynamic thresholds should follow the local ventilator-liberation protocol.

Evidence of some reversal of the cause of respiratory failureOxygenation is adequate for an SBT under the local protocolHemodynamics are sufficiently stable for a monitored trialPatient can initiate an inspiratory effortSedation and spontaneous-awakening plan have been coordinated when applicableCoordinate nursing, respiratory therapy, and the treating team.The team agrees that an SBT is appropriate now

2

Conduct the SBT

Trial setup

AARC supports an SBT with or without low-level pressure support. Use the technique and duration defined by the local protocol.

Baseline respiratory pattern, SpO₂, heart rate, blood pressure, and comfort documentedTechnique selected: T-piece, CPAP, or low-level PSV (8 cm H₂O or less)FiO₂ will remain at the pretrial settingAARC suggests not increasing FiO₂ during the SBT.Planned duration documentedAARC defines an SBT as usually 30–120 minutes.Appropriate monitoring, alarms, and rapid return to support are availableClinician responsible for monitoring and stopping the trial is identified

3

During the trial

Tolerance assessment

Assess trends and changes rather than relying on a single number. AARC highlights four domains: respiratory pattern, gas exchange, hemodynamics, and comfort.

Respiratory pattern and work of breathing remain acceptableGas exchange remains acceptable without increasing FiO₂Heart rate, rhythm, and blood pressure remain acceptableComfort, mental status, and visible distress remain acceptableNo clinically important deterioration from baseline is developingTrial outcome and reason for termination are documented

4

Do not conflate SBT and extubation

After the SBT

Passing an SBT addresses liberation potential. Extubation requires a separate airway and post-extubation assessment.

If the SBT was not tolerated, reversible causes are identified and addressedIf stopped, stable and comfortable ventilatory support is restoredAirway protection and level of responsiveness assessedCough strength and ability to clear secretions assessedCuff-leak testing considered only when risk for post-extubation stridor is highPost-extubation oxygen or preventive NIV plan considered for the patient’s risk profile

Reasons to stop and reassess

The AARC guideline emphasizes changes in respiratory pattern, gas exchange, hemodynamics, and comfort. Numeric thresholds vary across trials and local protocols, so this resource does not impose a universal cutoff.

Worsening respiratory distress, accessory-muscle use, paradoxical breathing, or diaphoresis

Clinically important deterioration in respiratory rate or breathing pattern

Sustained deterioration in oxygenation or ventilation under the local protocol

Hemodynamic instability, significant arrhythmia, or concerning chest discomfort

Worsening mental status, agitation, anxiety, or intolerance

Any clinician concern that continuing the trial is unsafe

SBT readiness

Asks whether a monitored trial is appropriate now. A simple safety screen is generally enough; RSBI is not required.

SBT tolerance

Assesses the patient’s response to minimal or no support across respiratory, gas-exchange, hemodynamic, and comfort domains.

Extubation readiness

Adds airway protection, cough, secretion clearance, upper-airway risk, and post-extubation support planning after the SBT.

SBT frequently asked questions

Is RSBI required before starting an SBT?

No. AARC’s 2024 guideline suggests that RSBI calculation is not needed to determine readiness for an SBT. Requiring an RSBI cutoff can unnecessarily delay a trial.

How should an SBT be performed?

AARC suggests that SBTs may be performed with or without low-level pressure support of 8 cm H₂O or less. T-piece, CPAP, or a protocol-defined low-support ventilator approach may be used.

How long does an SBT last?

The AARC guideline defines an SBT as a period of spontaneous breathing with minimal or no positive-pressure assistance, usually lasting 30–120 minutes. Follow the local protocol for technique and duration.

Does passing an SBT mean the patient should be extubated?

Not automatically. A successful SBT supports liberation assessment, but extubation also requires adequate airway protection, cough, secretion clearance, upper-airway assessment when indicated, and an appropriate post-extubation support plan.

Sources

1.Roberts KJ, Goodfellow LT, Battey-Muse CM, et al. AARC Clinical Practice Guideline: Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation. Respiratory Care. 2024;69(7):891–901. doi:10.4187/respcare.11735.
2.Ouellette DR, Patel S, Girard TD, et al. Liberation From Mechanical Ventilation in Critically Ill Adults: An Official CHEST/ATS Clinical Practice Guideline. Chest. 2017;151(1):166–180. doi:10.1016/j.chest.2016.10.036.
3.Girard TD, Alhazzani W, Kress JP, et al. ATS/CHEST Guideline: Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. American Journal of Respiratory and Critical Care Medicine. 2017;195(1):120–133. doi:10.1164/rccm.201610-2075ST.

Evidence reviewed August 29, 2026. This page is intended for adult mechanically ventilated patients; neonatal and pediatric liberation practices require population-specific protocols.

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