Extubation failure: diagnostic value of occlusion pressure (P0.1) and P0.1-derived parameters.

OBJECTIVE

To evaluate the ability of the new, built-in occlusion pressure (P0.1) measurement to predict extubation failure.

DESIGN AND SETTING

Prospective observational multicentre study in the ICU of five general hospitals.

PATIENTS

Hundred thirty patients on mechanical ventilation longer than 48 h when considered ready for weaning.

MEASUREMENTS AND RESULTS

Patients underwent a 30-min spontaneous breathing trial with simultaneous monitoring of occlusion pressure (P0.1) and breathing pattern (f/Vt). Sixteen patients (12%) failed the weaning trial and full ventilatory support was resumed, while 114 tolerated the trial and were extubated. Twenty-one (18%) required reintubation within 48 h. The area under the ROC curve for diagnosing extubation failure was 0.53 for f/Vt, 0.59 for P0.1 and 0.61 for P0.1f/Vt (p=NS). Accordingly, P0.1f/Vt more than 100 detected extubation failure with a sensitivity of 0.89, specificity of 0.35, positive predictive value of 0.21 and negative predictive value of 0.94.

CONCLUSION

During a first trial of spontaneous breathing on pressure support ventilation (PSV), bedside P0.1 and P0.1*f/Vt are of little help, if any, for predicting extubation failure.