Optimal clinical model predicting extubation failure remains unknown: large clinical trials have used a pragmatic 3-factors or a time consuming 11-factors model; and other aspects of weaning (e.g., screening, spontaneous breathing trial, post-extubation therapy) have never been considered as confounders in models predicting reintubation.

This large post-hoc study including patients with a wide range of risk, showed limited diagnostic capability of all the clinical models used for clinical decision making at the bed side. No meaningful improvement was observed after adjusting for aggressive spontaneous breathing trial (pressure support ≥ 7 cm H2O with or without positive end-expiratory pressure). A 4 factors model including age, chronic heart or lung disease, and prolonged mechanical ventilation could be used at the bed side to predict extubation failure and plan post-extubation respiratory therapy.