Telemedicine Intervention Impacts Spontaneous Breathing Trial Frequency and Ventilation DurationTelemedicine helps ICU patients breathe on their own faster

Critical care (London, England) Published August 8, 2026 Study authors: Adam Moritz F, Grunow Julius J, Edel Andreas, Steinecke Karin, Schuster Friederike S, Spies Claudia … PubMed ↗ NCT03671447 ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Telemedicine increases spontaneous breathing trial frequency and reduces mechanical ventilation duration for successfully weaned patients.

This secondary analysis of a stepped-wedge cluster-randomized controlled trial evaluates the impact of a complex telemedicine intervention on mechanical ventilation weaning protocols. The study involved 308 patients across ten intensive care units in Berlin, Germany. Patients were required to have been on invasive mechanical ventilation for at least two consecutive days and underwent at least one spontaneous breathing trial (SBT). The intervention consisted of daily telemedicine rounding involving both an intensivist and an ICU nurse.

The primary focus was determining if remote specialist involvement could optimize the weaning process. A key finding was a significant increase in the frequency of spontaneous breathing trials. Patients receiving the telemedicine intervention underwent SBTs at a rate of 51% per patient day, compared to only 27% in the control group (p < 0.001). This suggests that remote oversight may improve clinical vigilance regarding weaning readiness.

Despite the increase in trial frequency, several secondary outcomes did not reach statistical significance. The weaning classification and the overall weaning success rate showed no significant difference between the intervention and control cohorts (p = 0.21 and p = 0.32, respectively). Additionally, the raw time from the first SBT to successful weaning did not show a statistically significant difference in the univariate analysis.

However, multivariable regression analysis provided more nuanced insights into the timing of success. The model showed a statistically significant reduction in the time between the first SBT and successful weaning (beta = 0.56; 95% CI [0.32-0.98], p = 0.042). This suggests that while the total number of successes may not differ, the efficiency of the process following the initial trial is improved by telemedicine.

Furthermore, patients who were successfully weaned in the intervention group spent significantly less time on invasive mechanical ventilation compared to those in the control group (median 7 days vs. 9 days; p = 0.031). This indicates that while the intervention does not necessarily increase the absolute number of successful outcomes, it may streamline the clinical pathway for patients who are capable of being weaned. Clinicians should consider telemedicine as a tool to enhance the frequency of weaning assessments. While it did not change the ultimate success rate in this specific cohort, it significantly increased the volume of SBTs performed and reduced the median duration of ventilation for successful cases. These findings suggest that remote specialist involvement can optimize workflow and ensure more consistent application of weaning protocols in high-acuity settings.

When a patient is in an Intensive Care Unit (ICU) and requires a machine to help them breathe, every day counts. These patients are often very ill, and the goal of medical teams is to get them off these machines as safely and quickly as possible. This process is called weaning. Because it can be a complex task for busy doctors and nurses, researchers looked at how adding a telemedicine component could change the way care is delivered.

The study looked at over 300 patients in several ICUs in Berlin, Germany. These patients were already on breathing machines for at least two days. The researchers divided them into two groups. One group received standard care, while the other group received a complex telemedicine intervention. This involved daily rounds where an intensive care specialist and a nurse used video technology to check on the patients and determine if they were ready to try breathing on their own.

The results showed that patients in the telemedicine group underwent many more spontaneous breathing trials. A trial is a test to see if a patient can breathe without help from a machine. In the telemedicine group, these tests happened about 51% of the time, compared to only 27% in the standard care group. While both groups had similar success rates in eventually getting off the machines, those who did succeed in the telemedicine group spent less time on the ventilator overall. Specifically, the median time on a breathing machine was 7 days for the telemedicine group compared to 9 days for the standard group.

It is important to keep these findings in perspective. While the study showed that telemedicine helped patients try to breathe on their own more often and shortened the time spent on machines for those who succeeded, it did not significantly increase the overall success rate of getting off the machine. This means that while the process was more active, the final outcome of success remained similar between both groups. Because this is a secondary analysis of a larger trial, these results should be viewed as an early look at how technology can support hospital staff. It shows that telemedicine can be a helpful tool for doctors to manage their time and check on patients more frequently. For now, this means that while telemedicine is a promising way to help manage ICU care, it is one part of a larger team effort to get patients healthy.

What this means for you:

Telemedicine helped ICU patients try breathing tests more often and spend less time on machines if they succeeded.

Study Details

Study typeRct

Sample sizen = 1,463

EvidenceLevel 2

PublishedAug 2026

PMID42568095

TrialNCT03671447

View Original Abstract ↓

BACKGROUND: ICU patients commonly require invasive mechanical ventilation. Although weaning from ventilation is crucial for patient outcomes, it is commonly not performed according to guideline recommendations. We investigated if a complex telemedicine intervention improves the weaning process and outcomes. METHODS: This is a secondary analysis of the stepped-wedge cluster-randomized controlled Enhanced Recovery after Intensive Care (ERIC) trial, which was conducted among ten clusters of ICUs in the metropolitan area of Berlin, Germany. ERIC examined the impact of a complex telemedicine intervention, which included daily telemedicine rounding by an intensivist and ICU nurse, on the adherence to eight quality indicators of ICU care. We analyzed patients who received invasive mechanical ventilation for at least two consecutive days and at least one spontaneous breathing trial (SBT). We investigated the impact of the intervention on the weaning process and weaning outcomes using descriptive statistics and mixed-effects regressions. RESULTS: Of 1,463 patients enrolled in the trial, 308 patients were analyzed (control condition: 55; intervention condition: 253). Patients in the intervention group received significantly more SBTs than patients in the control group (51% vs 27% of the patient days; p < 0.001). There was no difference between the groups with respect to the weaning classification (p = 0.21), weaning success rate (28% vs 36%; p = 0.32), and time from the first SBT to successful weaning (2 [IQR 1, 5] vs 4 [IQR 1, 13] days; p = 0.12). The median time of invasive mechanical ventilation of successfully weaned patients was significantly shorter in the intervention than in the control group (7 [IQR 4, 10] vs 9 [IQR 6, 20] days; p = 0.031). In our multivariable regressions, the intervention was not associated with weaning success (OR for weaning failure: 1.45 [95%-CI 0.71-2.95]; p = 0.302), but with a shorter time between the first SBT and successful weaning (β = 0.56 [0.32-0.98]; p = 0.042). CONCLUSIONS: Although ICU telemedicine did not improve the weaning success rate, our findings indicate that it facilitates the exploitation of existing weaning potential by ensuring more frequent SBTs and thereby shortening ventilation duration of successfully weaned patients. The study is the first to highlight the potential of telemedicine to enhance ICU weaning practices. REGISTRATION: www. CLINICALTRIALS: gov (Identifier: NCT03671447; first submitted on August 22, 2018).

Telemedicine Intervention Impacts Spontaneous Breathing Trial Frequency and Ventilation DurationTelemedicine helps ICU patients breathe on their own faster

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Telemedicine Intervention Impacts Spontaneous Breathing Trial Frequency and Ventilation DurationTelemedicine helps ICU patients breathe on their own faster

Study Details

Intraosseous route for out-of-hospital cardiac arrest linked to lower outcomes than intravenous access

Using a bone needle instead of a vein line lowers survival chances for cardiac arrest patients

Clinical research that matters. Delivered to your inbox.

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