Diagnostic accuracy of tests for assessing readiness for liberation from mechanical ventilation in adults: an overview of reviews

Abstract
Objectives To summarize the evidence on the accuracy of tests evaluating readiness for liberation from mechanical
ventilation in the adult population.
Materials and methods Searches were conducted in MEDLINE, Embase, CENTRAL, and CINAHL, with additional
publications identified through conference proceedings and contact with experts. Systematic reviews (SRs) were
independently assessed for inclusion, data extraction, and risk of bias, without language or date restrictions. Included
SRs focused on adults diagnosed with ventilatory failure requiring invasive support for more than 24 h. Successful
weaning was considered being alive in absence of ventilatory support 72 h following liberation from mechanical
ventilation.
Results Ten SRs examining the diagnostic accuracy of 23 readiness tests were included. These tests were conducted
before, during, or after spontaneous breathing trials using various methods, such as pressure support, T-piece
and continuous positive airway pressure. Among these, lung ultrasound score (sensitivity 0.94, 95% CI 0.59–0.99;
specificity 0.87, 95% CI 0.62–0.97), diaphragmatic rapid shallow breathing index (sensitivity 0.84, 95% CI 0.76–0.90;
specificity 0.87, 95% CI 0.79–0.92), venous oxygen saturation (sensitivity 0.83, 95% CI 0.74–0.90; specificity 0.88, 95% CI
0.83–0.92), and brain natriuretic peptide (sensitivity 0.88, 95% CI 0.83–0.92; specificity 0.82, 95% CI 0.73–0.89), showed
high to moderate diagnostic capacity for ruling in and ruling out weaning failure. The remaining tests (e.g., cuff leak
test, cough peak flow, P0.1, RSBI, MIP, DE, DTF, DTF–RSBI, EeDT, and EiDT) demonstrated weak diagnostic accuracy. In
the SRs, risk of bias ranged from low to high.
Conclusions The accuracy of tests used to assess readiness for withdrawing ventilatory support in adults varies considerably.
Physicians should integrate the results of physiological, ultrasound, and paraclinical measures to minimize
uncertainty in deciding which patients should progress toward ventilator weaning, always considering individual
patient needs to ensure personalized healthcare.
Keywords Ventilator weaning, Airway extubation, Respiratory insufficiency, Ventilators mechanical, Diagnostic test
routine
Open Access
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