Respiratory failure & ventilation
The weaning index during spontaneous breathing trials for predicting extubation failure in critically ill patients: A bicentric prospective study
Authors' conclusion
SBT-induced changes in RR and WI demonstrated excellent performance in predicting EF in critically ill patients. In contrast, changes in EtCO2 during the SBT provided limited predictive value.
Study context
- Population
- ICU patients mechanically ventilated ≥48 h who tolerated a 30-minute spontaneous breathing trials (SBT)23 (20.2%) extubation failure
- Participants
- 114 participants
- Comparison
- Changes in EtCO2, RR and Weaning Index (WI) during SBT for predicting extubation failure
- Outcome
- Predictive performance for extubation failure (AUC)
- Follow-up
- Day 7
Methodological detailsprospective, bicentric
- Prospective
- Bicentric
Performance
As reported in the abstract
Discrimination for extubation failure
| Test or model | AUC |
|---|---|
| ΔEtCO2 | 0.70 [95%CI: 0.61-0.78] |
| ΔRR | 0.84 [95%CI: 0.76-0.90] |
| ΔWI | 0.91 [95%CI: 0.85-0.96] |
AUC
ΔEtCO20.70 [95%CI: 0.61-0.78]
ΔRR0.84 [95%CI: 0.76-0.90]
ΔWI0.91 [95%CI: 0.85-0.96]
Further findings
Increases in EtCO2, RR and WI and extubation failure (EF) (multivariate adjusted models)
| OR (95% CI) | ||
|---|---|---|
| ΔEtCO2Independently associated with EF · multivariate adjusted models | 1.78 (1.30–2.44) | |
| ΔRRIndependently associated with EF · multivariate adjusted models | 3.26 (1.77–6.01) | |
| ΔWIIndependently associated with EF · multivariate adjusted models | 1.03 (1.01–1.04) | |
| 0.10.31310Odds ratio (log scale) |
| Outcome | Failure | Success |
|---|---|---|
| Absolute changes during SBT, failure vs successMedian, mmHg | 1.0 (IQR −1.0–3.4) | −0.2 (IQR −0.2–1.0) |
| ΔRR median [IQR] breaths/min | 3 [1-5] | 0 [−1 to 1] |
| ΔWI median [IQR] mmHg × breaths/min | 169.0 [94.0-232.0] | — not stated in the abstract |
| ΔWI median [IQR] mmHg x breaths/min | — not stated in the abstract | −6.0 [−59.0 to 38.0] |
— not stated in the abstract
- Absolute changes during SBT, failure vs success: ΔEtCO2 p = 0.003; ΔRR p < 0.001; ΔWI p < 0.001
Original publication
The weaning index during spontaneous breathing trials for predicting extubation failure in critically ill patients: A bicentric prospective study. Anaesth Crit Care Pain Med. Published 20 March 2026. doi:10.
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