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Clinical criteria used to determine readiness for trials of spontaneous breathing

Required criteria

1. The cause of the respiratory failure has improved

2. PaO₂/FiO₂≥150* or SpO₂≥90 percent on FiO₂≤40 percent and positive end-expiratory pressure (PEEP) ≤5 cmH₂O

3. pH >7.25

4. Hemodynamic stability (no or low dose vasopressor medications)

5. Able to initiate an inspiratory effort

Additional criteria (optional criteria)

1. Hemoglobin ≥7 mg/dL

2. Core temperature ≤38 to 38.5°Centigrade

3. Mental status awake and alert or easily arousable

* 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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