‘It’s liberation not weaning’. Being Intubated is like being held captive– 'BAD'; the patient needs to be liberated from his ordeal.





Rounds during training involved making sure that Intubated patients were on a SBT (Spontaneous Breathing Trial) - adhering with the ‘Liberation Mantra.’





Next favorite query was – What’s your Reintubation Rate? Maybe it was a trick question – ‘Lower is better- right’? It was emphasized – 10-20% is acceptable. < 10% meant you are too conservative, your patients could have been liberated earlier, > 20% meant you were too cavalier in liberating them (they were not ready to be liberated – that’s a first; a person not ready for freedom).





Non-Invasive Ventilation(NIV) was making rapid gains while the concept of liberation was being touted. It was being used to keep patients form becoming captives (intubated), at risk patients could be extubated to NIV despite passing the breathing trial and reintubation prevented (still COPD patients were the main target).





Now comes the ' BREATHE trial' , Published in JAMA 2018;320(18):1881-1888. It was conducted across multiple ICU in UK. 364 patients who were on ventilator for 48 hrs. and had failed 1 spontaneous breathing trial were randomized. I82 were extubated to NIV & protocolized weaning of NIV, while 182 were in Invasive arm and weaned per protocol.The study showed that the time to liberation from ventilation (NIV or Invasive)) was same (NIV - 4.3 days; Invasive- 4.5 days). For secondary outcomes, patients extubated to NIV obviously spent less time on invasive ventilation. The rate of reintubation (37% vs 28%) and survival rates were same in both arms.



