The weaning index during spontaneous breathing trials for predicting extubation failure in critically ill patients: A bicentric prospective study - 03/10/26
, Nicolas Storme d, Mohamed Askalany a, Mohamed Helal a, Mehraj Ud Din a, Sujay Samanta a, Sukhen Samanta a, Fadi Hamed a, Umesh Edke a, Tiago Carvalho a, Bruno De Oliveira a, Hussam Elkambergy a, Jamil Dibu a, Ahmad Bayrlee a, Haamid Siddique a, Rehan Haque a, Nahla Aljaberi a, Samer Shoshan a, Dnyaneshwar Munde a, Mathieu Guilbart e, Ujwal Dhundi a, Noora Alhajri f, Maryam Babar f, Mehdi Belfegas e, Ayo Mandi a, Umar Khan a, Ihab Ahmed a, Tariq Omer a, Yeldho Varghese a, Mathieu Metzelard e, Arvin Charles g, Muhammed Kacherintavida g, Christophe Beyls e, Mohammed Aljasmi a, Baraa Abduljawad a, Khaled Ismail a, Yazine Mahjoub e, Osama Abou-Arab eAbstract |
Background |
An increase in the Weaning Index (WI), defined as the product of end-tidal carbon dioxide (EtCO 2 ) and respiratory rate (RR), has been observed in patients who fail spontaneous breathing trials (SBT). This study aimed to assess whether the WI recorded during SBT can predict extubation failure (EF) in critically ill patients.
Methods |
In this bicentric prospective study, ICU patients mechanically ventilated for at least 48 h and who successfully tolerated a 30-minute SBT were included. EtCO 2 , RR, and WI were recorded at the beginning and end of the SBT. Changes in these parameters were analysed. Predictive performance for EF on day 7 was assessed, including areas under the receiver operating characteristic curves (AUCs).
Results |
Among the 114 patients, 23 (20.2%) experienced EF. Absolute changes (median [IQR]) of EtCO 2 , RR and WI were higher in failure group than success group respectively: 1.0 [−1.0 to 3.4] mmHg, 3 [1–5] breaths/min and 169.0 [94.0–232.0] mmHg × breaths/min versus −0.2 [-0.2 to 1.0] mmHg ( p = 0.003), 0 [−1 to 1] breaths/min ( p < 0.001) and −6.0 [−59.0 to 38.0] mmHg x breaths/min ( p < 0.001). In multivariate adjusted models, increases in EtCO 2 , RR, and WI were independently associated with EF, respectives OR [95% CI]: 1.78 [1.30−2.44], 3.26 [1.77−6.01], and 1.03 [1.01−1.04]. ΔEtCO 2 showed limited predictive ability for EF (AUC = 0.70 [95%CI: 0.61−0.78]), whereas ΔRR and ΔWI demonstrated excellent discrimination (AUC = 0.84 [95%CI: 0.76−0.90] and AUC = 0.91 [95%CI: 0.85−0.96]).
Conclusions |
SBT-induced changes in RR and WI demonstrated excellent performance in predicting EF in critically ill patients. In contrast, changes in EtCO 2 during the SBT provided limited predictive value.
Registration |
The study was registered in the ClinicalTrials.gov registry: NCT05802745.
Le texte complet de cet article est disponible en PDF.Abbreviations : AUC, BMI, CI, CO 2 , CV within , EF, EtCO 2 , FiO 2 , HR, ICU, LSC, P0.1, PaCO 2 , PEEP, PSV, RR, SaO 2 , SAPS, SBT, SD within , SOFA, SpO 2 , Vt, WI
Keywords : Extubation failure, End-tidal carbon dioxide, Spontaneous breathing trial, Shallow breath index, Respiratory rate, Weaning index
Plan
Vol 45 - N° 6
Article 101819- novembre 2026 Retour au numéro
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