RCT

FAST

Frequency of Screening and Spontaneous Breathing Trial Techniques: A Randomized Clinical Trial

JAMA, 2024 · Multicenter 2x2 factorial randomized clinical trial (n=797)

Clinical question

Do more frequent readiness screening or pressure-supported SBTs shorten time to successful extubation?

Population: Adults invasively ventilated for at least 24 hours
Intervention: More frequent vs once-daily screening and pressure-supported vs T-piece SBT
Comparator: Alternative screening frequency/SBT technique
Primary outcome: Time to successful extubation
Result: There were no significant main-effect differences by screening frequency or SBT technique. An unexpected interaction suggested more frequent screening combined with pressure-supported SBTs delayed successful extubation.

What the trial found

Neither more frequent screening nor pressure-supported SBTs universally shortened successful extubation.

Current guideline position

Use structured liberation screening and an accepted SBT technique, interpreted in clinical context.

Clinical interpretation

Daily protocolized readiness assessment remains reasonable; do not teach one SBT technique or increased screening frequency as universally superior.

Clinical Context & Relevant Topics (1)

Disease Reference

Invasive Mechanical Ventilation

Complete clinical topic overview. For the full 10-level interactive course, visit Master MV. Covers core ventilator modes, respiratory mechanics (Cstat, Raw, driving pressure), waveform dyssynchrony analysis, VILI prevention, and liberation protocols.

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