Role of ventilator and ultrasound parameters in predicting extubation success

The gold standard method for an accurate and easy way to predict successful weaning has not been established. The study was aimed to determine the predictive values of airway occlusion pressure (P0.1), parasternal intercostal muscle, and diaphragm for successful extubation and their correlation with ICU length of stay and duration of mechanical ventilation. We recruited patients who had been admitted to ICU and mechanically ventilated for at least 48 h. Patients who had successfully passed the spontaneous breathing trial (SBT) and planned for extubation were screened. P 0.1 parameter was obtained from the ventilator. We measured parasternal intercostal muscle thickness (PIMT), parasternal intercostal muscle thickening fraction (PIMTF), diaphragm thickness (DT) and diaphragm thickening fraction (DTF). Primary outcome was to determine the predictive values of P 0.1, PIMTF & DTF for successful extubation. Of the 126 enrolled patients, 101(80.1%) were successfully extubated and 25 (19.8%) had extubation failure. The predictive thresholds for successful extubation for P 0.1 was 1.8 cm of H₂O (88% sensitivity and 81% specificity with area under receiver operating characteristic curve (AUC) of 0.907, for PIMTF was 12.5% (100% sensitivity and 98% specificity with AUC 0.999), and for DTF was 22.8% (84% sensitivity and 94% specificity with AUC 0.907). P0.1, PIMTF, and DTF are independently linked to extubation outcomes and a combination of these three variables could serve as a valuable tool for accurate prediction of successful extubation.