Clinical prediction scores predicting weaning failure from invasive mechanical ventilation: Role and limitations

Abstract

Invasive mechanical ventilation (IMV) has become integral to modern-day critical care. Even though critically ill patients frequently require IMV support, weaning from IMV remains an arduous task, with the reported weaning failure (WF) rates being as high as 50%. Optimizing the timing for weaning may aid in reducing time spent on the ventilator, associated adverse effects, patient discomfort, and medical care costs. Since weaning is a complex process and WF is often multi-factorial, several weaning scores have been developed to predict WF and aid decision-making. These scores are based on the patient's physiological and ventilatory parameters, but each has limitations. This review highlights the current role and limitations of the various clinical prediction scores available to predict WF.

Keywords: Clinical scores; Invasive mechanical ventilation; RSBI; Weaning; Weaning failure

Core Tip: Delay in weaning from invasive mechanical ventilation or weaning failure (WF) may increase patient mortality, morbidity, risk of secondary infections, length of hospital/ICU stay and healthcare costs. Physician’s ability to predict successful weaning has been shown to have low accuracy, with poor positive and negative predictive values. As the pathophysiology of WF is complex and multifactorial, a single parameter may not suffice to predict successful weaning. Hence, several clinical scores, encompassing multiple patients and ventilatory factors have been devised to predict WF. However, none of the current scores is ideal and each have their inherent limitations.