Development and validation of a mechanical power-oriented prediction model of weaning failure in mechanically ventilated patients: a retrospective cohort study

Abstract

ObjectiveTo develop and validate a mechanical power (MP)-oriented prediction model of weaning failure in mechanically ventilated patients.DesignA retrospective cohort study.SettingData were collected from the large US Medical Information Mart for Intensive Care-IV (MIMIC-IV) V.1.0, which integrates comprehensive clinical data from 76 540 intensive care unit (ICU) admissions from 2008 to 2019.ParticipantsA total of 3695 patients with invasive mechanical ventilation for more than 24 hours and weaned with T-tube ventilation strategies were enrolled from the MIMIC-IV database.Primary and secondary outcomeWeaning failure.ResultsAll eligible patients were randomised into development cohorts (n=2586, 70%) and validation cohorts (n=1109, 30%). Multivariate logistic regression analysis of the development cohort showed that positive end-expiratory pressure, dynamic lung compliance, MP, inspired oxygen concentration, length of ICU stay and invasive mechanical ventilation duration were independent predictors of weaning failure. Calibration curves showed good correlation between predicted and observed outcomes. The prediction model showed accurate discrimination in the development and validation cohorts, with area under the receiver operating characteristic curve values of 0.828 (95% CI: 0.812 to 0.844) and 0.833 (95% CI: 0.809 to 0.857), respectively. Decision curve analysis indicated that the predictive model was clinically beneficial.ConclusionThe MP-oriented model of weaning failure accurately predicts the risk of weaning failure in mechanical ventilation patients and provides valuable information for clinicians making decisions on weaning.

Mechanical power density, spontaneous breathing indexes, and prolonged weaning failure: a prospective cohort study

“…MP density was significantly more accurate than traditional indexes (e.g., minute ventilation, VT/PBW, RSBI, or IWI) in predicting weaning outcomes, most likely because it better reflects prolonged weaning failure`s underlying pathophysiology, apparently an excessive respiratory muscle effort for carbon dioxide elimination. This aligns with previous studies on MP and weaning, in which MP density (e.g., LTC dyn -MP) has consistently demonstrated the most robust predictive ability regarding failure to wean 6 , 7 , 20 . This index incorporates respiratory rate and airway pressures, factors that also have been independently associated with weaning failure in the recent multicenter WEAN SAFE study 21 .…”