Predicting Extubation Outcomes in Pneumonia - A Systematic Review of Ventilatory Indices

ObjectiveThis systematic review aimed to describe the use of ventilatory indices for assessing extubation outcomes in adults with pneumonia.MethodsWe included observational studies with adults; under mechanical ventilation (MV) for more than 24 h due to respiratory failure caused by pneumonia; and assessed using any index test of extubation outcomes. Extubation outcomes was the primary outcome. The search was conducted in MEDLINE/PubMed, EMBASE/Elsevier, Cochrane Library, Web of Science, and CINAHL/EBSCOhost Web. Descriptive synthesis was used as the analytical strategy for the results.ResultsThree studies were included in this review. The spontaneous breathing trial (SBT) was used as a ventilatory index test to predict extubation failure. To define a successful SBT, a ventilatory index was taken into consideration: the rapid shallow breathing index (RSBI). The rate of extubation failure varied from 7% to 38% following a successful SBT and was 13% after a failed SBT.ConclusionThis review identified only three methodologically limited, retrospective studies. The current evidence is insufficient to support the predictive utility of ventilatory indices for extubation failure in pneumonia. While SBT can determine a patient's ability to breathe independently, this ability did not reliably predict extubation success in the available literature. Future prospective studies are urgently needed to develop and validate reliable extubation criteria for this population.