Assessment of preparedness of weaning has been recommended before extubation for mechanically ventilated patients. We aimed to understand the association of a structured assessment of weaning preparedness with successful liberation. Methods: We retrospectively investigated patients with acute respiratory failure who experienced an extubation trial at the medical intensive care units of a medical center, and compared the demographic and clinical characteristics between those patients with

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... ful and failed extubation. A composite score to assess the preparedness of weaning, the WEANS NOW score, was generated consisting of eight components, including Weaning parameters, Endotracheal tube, Arterial blood gas analysis, Nutrition, Secretions, Neuromuscular-affecting agents, Obstructive airway problems, and Wakefulness. The prognostic ability of the WEANSNOW score for extubation was then analyzed. Results: Of the 205 patients included, 138 (67.3%) patients had successful extubation. Compared with the failure group, the success group had a significantly shorter duration of MV before the weaning attempt (11.2±11.6 vs. 31.7±26.2 days, p<0.001), more with congestive heart failure (42.0% vs. 25.4%, p=0.020), and had different distribution of the types of acute respiratory failure (p=0.037). The failure group also had a higher WEANS NOW score (1.22 ± 0.85 vs.0.51 ± 0.71, p<0.001) and worse Rapid Shallow Breathing Index (93.9 ± 63.8 vs. 56.3± 35.1, p<0.001). Multivariate logistic regression analysis showed that a WEANS NOW Score=1 or higher (OR=2.880, 95% CI=1.291-6.426, p=0.010) and intubation duration > 21 days (OR=7.752, p<0.001) were independently associated with an increased probability of extubation failure. Conclusion: Assessing the pre-extubation status of intubated patients in a checklist-based approach using the WEANS NOW score might provide valuable insights into extubation failure in patients in a medical ICU for acute respiratory failure. Further prospective studies are warranted to elucidate the practice of assessing weaning preparedness. PeerJ reviewing PDF |