Supplemental Digital Content Figure 1: Enrolment Procedure
Daily Screening of all ICU patients:
>18 yrs of age Intubated >36 hours
Exclude if:
Exclusion Criteria:
Successful SBT awaiting extubation Withdrawal of life support considered High spinal cord injury
Neurosurgical patient Neuromuscular disease Follow using daily eligibility checklist until meet all
Clinical Stability Criteria to trial mode of partial ventilatory support (PAV or PSV):
partial/complete reversal of cause of respiratory failure
body temperature between 36ºC and 39ºC metabolic disorders corrected; pH >7.32 hemoglobin >70 g/L; no ongoing bleeding stable hemodynamic status
Able to trigger
PaO2 ≥ 60 mmHg or SaO2 ≥ 90% on FiO2≤ 0.60 and PEEP ≤ 15 cm H2O
AC/VC: Pplat≤30cmH2O with Vt 6-8 ml/kg OR AC/PC: PC+PEEP≤30cmH2O
Exclude if: Exclusion Criteria:
Has met all Criteria for Switching to Spontaneous Mode of Ventilation
>24 hours Pre-inclusion Test on PSV 15 cmH2O for 30 minutes
Patient fails Pre-inclusion test:
Return to AC ventilation and reassess within 24 hour
Patient passes Pre-inclusion test:
Assess for Criteria to Initiate Weaning:
PaO2/FiO2>200 on FiO2 ≤0.50 and PEEP ≤8 cmH2O No inotropes/vasopressors except low dose dopamine
RSBI <105: Patient passes Pre-SBT readiness assessment Proceed to SBT:
Place patient on CPAP 5 cmH2O and FiO2 0.40 for 30 minutes Patient does not meet Criteria
to Initiate Weaning
Patient meets Criteria to Initiate Weaning:
Proceed to Pre-SBT readiness assessment:
Place patient on CPAP for 1-2 min, measure RSBI
RSBI≥ 105: Patient fails Pre-SBT readiness assessment
Patient passes SBT Patient fails SBT
Exclude if:
Exclusion Criteria:
Passed SBT and tolerating PSV≤7cmH2O and PEEP≤5 cmH2O while awaiting extubation Obtain informed
consent from Patient or SDM as soon as available (deferred consent permitted)
Randomize
Exclude if:
Exclusion Criteria:
Patient/ SDM refuse consent
