Airway Occlusion Pressure Derived Parameters During Spotaneous Breathing Trial for Predicting Extubation Failure

The Predictive Value of Airway Occlusion Pressure Derived Parameters During Spontaneous Breathing Trial on Successful Weaning From Mechanical Ventilation

Weaning from invasive mechanical ventilation (IMV) is a critical stage of the intensive care unit (ICU) stay. Premature IMV discontinuation may expose patients to substantial cardiopulmonary stress, whereas prolonged weaning increases exposure to complications associated with IMV, including ventilator-associated pneumonia (VAP), diaphragmatic muscle atrophy, and barotrauma.

Extubation failure, defined as the need for reintubation within 48-72 h after extubation, occurs in approximately 10-15% of patients reaching 20% in high-risk patients including factors of age >65 years, chronic cardiac or respiratory disease, IMV duration >7 days. Extubation failure is associated with substantial morbidity and mortality, with reported hospital mortality rates up to 25-50%, as well as prolonged ICU length of stay and increased healthcare costs.

Modern ventilators provide simple, non-invasive access to two complementary physiological indices: the airway occlusion pressure at 100 ms (P0.1), a surrogate of central respiratory drive, and the change in inspiratory pressure during an occlusion maneuver (ΔPocc), a marker of the overall inspiratory effort.

This study assesses the predictive value of P0.1 and ΔPocc measured before and during an SBT for predicting reintubation within 3 days after extubation.

Inclusion Criteria:

Adult patients meeting all the weaning criteria set out in the consensus of the International Conference on Weaning:

• Duration of mechanical ventilation prior to the first weaning trial > 24 hours
• Respiratory rate ≤ 35 breaths/min,
• Adequate oxygenation defined as SpO₂ ≥ 90% with FiO₂ ≤ 0.4 or PaO₂/FiO₂ ≥ 150 mm Hg with PEEP ≤ 8 cmH₂O,
• Adequate cough reflex,
• A conscious patient who is responsive to commands and has a RASS (Richmond Agitation Sedation Scale) score between +1 and -2
• Haemodynamically stable without vasopressors or on a minimal dose (noradrenaline <0.1 µg/kg/min)
• Patient informed about the study and expressing no objection to participating

Exclusion Criteria:

• Patients with neurological injury and a Glasgow Motor Score of ≤ M5
• Decision not to reintubate in the event of extubation failure
• Adults subject to legal protection (judicial protection, curatorship, guardianship), and persons deprived of their liberty