Evaluation of Mechanical Power and Ventilator Parameters to Predict Weaning Success in the Intensive Care Unit

This is a prospective, observational, single-center study designed to investigate whether ventilator-derived physiological measurements can predict weaning success in mechanically ventilated adult ICU patients. The primary objective is to determine the prognostic value of mechanical power (MP) in forecasting successful extubation.

Secondary objectives include the evaluation of additional respiratory parameters such as airway occlusion pressure (P0.1), negative inspiratory force (NIF), the rapid shallow breathing index (RSBI), and the mechanical power/negative inspiratory force ratio (MP/NIF). These parameters will be measured at the bedside within 2 hours after patients meet clinical weaning criteria and are hemodynamically stable.

All participants will be monitored for 48 hours after extubation. Weaning success is defined as the ability to sustain spontaneous breathing without the need for reintubation after extubation during this period.

Data collection will include:

Respiratory measurements obtained from the ventilator: MP, P0.1, NIF, RSBI, and MP/NIF.

Demographic and clinical data: age, sex, BMI, ICU admission diagnosis, APACHE II scores, ventilator settings, and duration of mechanical ventilation.

Post-extubation follow-up: reintubation, non-invasive ventilation or high-flow oxygen use, SpO₂ values, blood gas analysis, and vital signs.

This study does not involve any interventions beyond standard ICU care. Ventilator-based respiratory assessments are routinely performed in ICU settings and pose no additional risk to participants.

The results may support the integration of load-drive-capacity assessment into routine ICU weaning protocols and improve clinical decision-making by reducing the incidence of weaning failure and associated complications.

Inclusion criteria

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Age ≥ 18 years (adult patient population)

• Patients receiving invasive mechanical ventilation in the intensive care unit
• Having been intubated for at least 24 hours
• Patients for whom the clinical team has decided extubation and who meet the following weaning criteria:
• Stable respiratory parameters (FiO₂ ≤ 50%, PEEP ≤ 7 cmH₂O, SpO₂ ≥ 92%)
• Hemodynamic stability (no inotropic support or minimal/stable dose)
• Stable acid-base balance
• Adequate secretion control
• Technically suitable ventilator and measurement conditions
• Written informed consent obtained from the patient or legal representative

Exclusion criteria

• Patients with any of the following conditions will be excluded:

and

• Individuals under 18 years of age
• Pregnant patients
• Patients who do not meet the weaning criteria
• Tracheostomized patients
• Neuromuscular diseases (e.g., Guillain-Barré syndrome, Duchenne muscular dystrophy, etc.)
• Technical inadequacy preventing correct ventilator measurements
• Significant asynchrony (e.g., auto-PEEP, double triggering, ineffective triggering, cycle asynchrony, auto-triggering)
• Patients without an extubation plan or those receiving palliative care
• RASS ≤ -2 (excessive sedation) for PSV mode measurements
• RASS ≥ +2 (agitation) for PSV-CPAP mode measurements
• Patients with delirium for PSV-CPAP mode measurements
• Patients who cannot provide consent, have no legal representative, or whose representative refuses consent