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

Abstract

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 P0.1*f/Vt (p=NS). Accordingly, P0.1*f/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.