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| Name | Class |
|---|---|
| Fujian Provincial Hospital | OTHER |
| Peking Union Medical College Hospital | OTHER |
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Accurate prediction of readiness to liberate patients from mechanical ventilation remains challenging. Conventional indices such as the rapid shallow breathing index (RSBI) and maximal inspiratory pressure (MIP) often miss early signs of injurious breathing patterns or regional ventilation asynchrony that can lead to extubation failure. Electrical impedance tomography (EIT) provides continuous, non-invasive imaging of regional lung ventilation. We developed a novel EIT-derived Flow Index (FI) which integrates the magnitude of inspiratory effort with the temporal synchrony of lung filling. This prospective, multicenter observational study aimed to (1) validate the predictive value of FI during spontaneous breathing trials (SBT) compared with conventional weaning indices, and (2) compare the predictive ability of EFI with traditional weaning indices(RSBI,MIP,P0.1).
This multicenter observational study was conducted in three tertiary ICUs in China. Adult patients (≥18 years) receiving invasive mechanical ventilation for ≥48 hours and meeting readiness criteria underwent a standardized 30-minute pressure support SBT (PS 8 cmH₂O, PEEP 5 cmH₂O, FiO₂ ≤0.5) with continuous EIT monitoring. EFI was calculated breath by breath from the global impedance-time signal. Conventional weaning indices (RSBI, MIP, P0.1) and physiological variables were recorded.
Primary endpoint: SBT success (completion of 30-minute SBT without predefined failure criteria).
Key secondary endpoint: reintubation within 48 hours after extubation. Other secondary endpoints: ventilator-free days at day 7 (VFD-7), ICU mortality. Predictive performance was assessed using ROC analysis. The EFI cutoff value was derived from the primary endpoint analysis and carried forward for post-extubation risk stratification.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional method Respiratory Drive group | Conventional method Respiratory Drive group（Methods include: esophageal pressure monitoring, airway obstruction pressure (P0.1) ) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| electrical impedance tomography | Device | Respiratory drive assessed by flow index measured by electrical impedance tomography. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Spontaneous Breathing Trial (SBT) Success Rate | Proportion of patients who complete the 30-minute Spontaneous Breathing Trial (SBT) without signs of respiratory distress, hypoxemia, or hemodynamic instability. | Within 30 minutes of Spontaneous Breathing Trial (SBT) |
| Measure | Description | Time Frame |
|---|---|---|
| Reintubation Rate within 48 hours | Proportion of patients requiring reintubation within 48 hours following successful extubation. | Within 48 hours after extubation. |
| Ventilator-Free Days by Day 7 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Hongping Qu | Department of Critical Care Medicine，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine | Study Chair |
| Jialin Liu | Department of Critical Care Medicine，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine | Study Director |
| rui zhang | Department of Critical Care Medicine，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Peking Union Medical College Hospital | Beijing | Beijing Municipality | China | |||
| Fujian Provincial Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42219497 | Derived | Zhang R, Xu J, Wu J, Tan R, He H, Long Y, Hong D, Wu D, Qu H, Zhao Z, Liu J. Electrical impedance tomography-derived flow index during spontaneous breathing trial stratifies the risk of reintubation within 48 h after extubation. Crit Care. 2026 May 31. doi: 10.1186/s13054-026-06098-3. Online ahead of print. |
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The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation
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Number of days free from mechanical ventilation within 7 days after extubation.
| Within 7 days after extubation. |
| ICU Mortality | Mortality rate of patients during their ICU stay in this study. | during the ICU stay or within 24 hours following transfer out of the ICU |
| Reintubation rate within 48 hours after extubation | Proportion of patients who successfully completed the spontaneous breathing trial (SBT) and underwent planned extubation who required reintubation within 48 hours after extubation. | within the 48 hours after extubation |
| Ventilator-Free Days at Day 7 (VFD-7) | Number of days alive and free from invasive mechanical ventilation within 7 days after extubation. Days after reintubation are not counted as ventilator-free days. | Within 7 days after extubation |
| ICU Mortality | Proportion of patients who died during ICU hospitalization or within 24 hours after transfer out of the ICU. | During ICU stay or within 24 hours after ICU discharge |
| Fuzhou |
| Fujian |
| 200025 |
| China |
| Department of Critical Care Medicine，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine，Shanghai，China. | Shanghai | 200025 | China |