Abstract
BACKGROUND: Patients undergoing weaning from mechanical ventilation face the risks of reintubation. Spontaneous breathing trials (SBTs), including T-piece (SBT-T) and pressure support (SBT-P), are commonly used to assess extubation readiness. Current guidelines favor the use of SBT-P. Weaning-induced pulmonary edema (WIPO) is common after extubation, which could lead to extubation failure. CASE: We report the case of a patient on ventilation who failed the first extubation attempt following successful SBT-P due to WIPO. SBT-T was implemented for the patient in the second weaning attempt. METHODS: During the subsequent SBT-T, signs of WIPO recurred. Instead of terminating the trial, we managed the patient with intensive monitoring, fluid management, and blood pressure control. RESULT: After targeted interventions, this patient was successfully extubated during the second weaning attempt. CONCLUSION: This case highlights the utility of SBT-T in unmasking WIPO risk in weaning patients with cardiac dysfunction. By enabling proactive management during the trial, SBT-T may enhance safety in high-risk populations.