Predictive Value of Airway Occlusion Pressure, Maximal Inspiratory Pressure and Their Ratio for Successful Extubation in Patients with Traumatic Brain Injury

Background: The treatment of mechanical ventilation (MV) is essential for patients who have experienced traumatic brain injury (TBI); however, it is associated with a variety of complications. This study aimed to assess the predictive value of respiratory muscle factors, such as maximal inspiratory pressure (PIMax), and central drive indicators, such as airway occlusion pressure (P0.1) and their ratio, in predicting the success of MV withdrawal in patients with TBI. Methods: In this prospective observational study, 60 ventilated TBI patients who were eligible for weaning were examined for a period of two hours, spontaneous breathing trials were implemented for all patients, utilizing low-level pressure support ventilation. The ventilator supplied the P0.1 and PIMax values. Results: PIMax can significantly predict successful ventilator weaning with AUC of 0.786, P-value -23 CmH2O with 78.95% sensitivity, 60.98% specificity. P0.1 was a significant predictor of successful ventilator weaning with AUC of 0.720, P-value of 0.010, and at cutoff value >2.6 CmH2O with 73.68% sensitivity, 51.22% specificity. P0.1/ PIMax ratio can significantly predict successful ventilator weaning with AUC of 0.776, P= 0.001, and at cutoff value >0.11 CmH2O with 84.21% sensitivity, 56.10% specificity. Conclusion: The weaning prognosis in TBI patients may be predicted by PIMax, P0.1, and the ratio of P0.1/PIMax, as evidenced by their moderate predictive accuracy. Patients with successful weaning showed lower ratio of P0.1/PIMax, PIMax, P0.1 higher PaO2/FiO2 ratio, lower RSBI, and lower number of days in the ICU.