Rathish M, Renuka M K, Prasant Nvsn, Sailaja Baby
Department of Critical Care Medicine, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, India.
Lung India. 2025 May 1;42(3):211-217. doi: 10.4103/lungindia.lungindia_583_24. Epub 2025 Apr 29.
Pulmonary complications from mechanical ventilation are a significant concern in intensive care. Reducing the duration of respiratory support is vital to minimize these risks. Extubation, the final step in the weaning process, is critical. Most weaning indices rely on complex ventilatory parameters. This study aimed to evaluate the utility of the heart rate, acidosis, Glasgow Coma Scale, oxygenation, respiratory rate (HACOR) score, and Lung Ultrasound Score (LUS) as predictors of weaning outcomes in the intensive care unit.
This prospective observational study was conducted in the Department of Critical Care Medicine at Sri Ramachandra Institute of Higher Education and Research, involving 100 patients aged 18 years and above. Both the HACOR score and LUS were assessed at the 30th minute during a 60-minute spontaneous breathing trial (SBT).
Of the 100 patients, 65 (65%) were successfully weaned, while 35 (35%) experienced weaning failure. The median HACOR score was 3 (interquartile range: 0-3) in the successful group and 6 (IQR: 5-8) in the failed group. The median LUS was 10 (IQR: 8-10) in the successful group and 16 (IQR: 13-16) in the failed group. A HACOR score ≥5 predicted weaning failure with a sensitivity of 87.7%, specificity of 77.1%, and area under the curve of 0.824. The LUS had an area under curve of 0.831, sensitivity of 86.2%, specificity of 80% at a threshold of ≥13 for failure.
A HACOR score of ≥5 and a Lung Ultrasound Score of ≥13 are excellent predictors of weaning failure and can be incorporated into ICU weaning strategies.
机械通气引起的肺部并发症是重症监护中的一个重要问题。缩短呼吸支持时间对于将这些风险降至最低至关重要。拔管是撤机过程的最后一步，至关重要。大多数撤机指标依赖于复杂的通气参数。本研究旨在评估心率、酸中毒、格拉斯哥昏迷量表、氧合、呼吸频率（HACOR）评分和肺部超声评分（LUS）作为重症监护病房撤机结果预测指标的效用。
这项前瞻性观察性研究在斯里兰卡拉马钱德拉高等教育与研究学院重症医学科进行，纳入了100名18岁及以上的患者。在60分钟自主呼吸试验（SBT）的第30分钟评估HACOR评分和LUS。
100名患者中，65例（65%）成功撤机，35例（35%）撤机失败。成功组的HACOR评分中位数为3（四分位间距：0 - 3），失败组为6（四分位间距：5 - 8）。成功组的LUS中位数为10（四分位间距：8 - 10），失败组为16（四分位间距：13 - 16）。HACOR评分≥5预测撤机失败的敏感度为87.7%，特异度为77.1%，曲线下面积为0.824。LUS曲线下面积为0.831，在失败阈值≥13时，敏感度为86.2%，特异度为80%。
HACOR评分≥5和肺部超声评分≥13是撤机失败的优秀预测指标，可纳入重症监护病房的撤机策略。
