Respiratory failure & ventilation
Best clinical model predicting extubation failure: a diagnostic accuracy post hoc analysis
Authors' conclusion
Based on these results, the 3-factors model reported a very low diagnostic accuracy, and the 4 or 11-factors models showed similar low accuracy. No improvement was observed after adjusting for other aspects of weaning.
Study context
- Population
- Patients at all risk of extubation failure included in five multicentre randomised trials
- Participants
- 2,341 patients · 5 RCTs
- Comparison
- 3-factors model vs 4-factors model vs 11-factors model
- Outcome
- Diagnostic accuracy (Youden and Kappa indexes) for all-cause reintubation
- Follow-up
- 7 days
Methodological detailspost hoc analysis of five multicentre RCTs
- Post hoc analysis of five multicentre RCTs
Performance
As reported in the abstract
All-cause reintubation at 7 days, crude models
| Test or model | Youden index | Kappa index |
|---|---|---|
| 3-factors model | 0.08 | 0.04 |
| 4-factors model | 0.12 | 0.06 |
| 11-factors model | 0.16 | 0.07 |
Youden index
3-factors model0.08
4-factors model0.12
11-factors model0.16
Kappa index
3-factors model0.04
4-factors model0.06
11-factors model0.07
Further findings
Spontaneous breathing trial (SBT)-adjusted models (Youden/Kappa index) · 7 days
- All adjusted models had low diagnostic capability (3-, 4- and 11-factors models respectively)
- 0.08/0.03, 0.07/0.03, and 0.06/0.02
Aggressive SBT strategies (pressure support ≥ 7 cm H2O with or without PEEP) and extubation failure risk
- Associated with extubation failure risk
- P < 0.001
Original publication
Best clinical model predicting extubation failure: a diagnostic accuracy post hoc analysis. Intensive Care Med. Published 7 January 2025. doi:10.
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