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Based on studies completed during the past 2 decades, many intensive care units (ICU) have adopted protocols to regularly assess readiness for extubation (Lancet 2008; 371:126). Once a patient passes a spontaneous breathing trial (SBT), practices vary widely. Although studies have shown benefit for extubation to noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC; NEJM JW Gen Med Dec 1 2019 and JAMA 2019; 322:1465), the value of a protocol to implement one over the other has not been demonstrated.
Investigators at Vanderbilt randomized two ICUs to 3-month blocks of either protocolized postextubation support or usual care; 751 patients were included in the study. The protocol recommended NIV for patients with chronic obstructive p…