Multi-parameter prediction of extubation failure using spontaneous breathing trial and post-spontaneous breathing trial rest period data.

Objective: While extubation failure in critically ill patients is a significant challenge in intensive care units (ICUs), traditional predictors, such as the rapid shallow breathing index (RSBI), offer limited accuracy. This study aimed to develop a machine-learning model using data collected during a spontaneous breathing trial (SBT) and the rest period after SBT to improve the prediction of extubation failure. Methods: This retrospective and single-center cohort study analyzed data from 413 extubation cases involving 372 patients across both medical and surgical ICUs. Vital signs and ventilatory parameters were collected during the SBT and post-SBT rest period. A light gradient-boosting machine (LGBM) algorithm was employed, incorporating features derived from these vital signs. The model's performance was assessed using the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve (AUPRC), sensitivity, and specificity. Results: Among the included cases, 11.01% experienced extubation failure. The LGBM model, which integrated data from both SBT and post-SBT rest periods, along with RSBI, achieved the highest performance (AUROC: 0.789, AUPRC: 0.451). Key predictors included ICU duration, RSBI, and respiratory rate during SBT. Models utilizing only SBT or rest period data individually demonstrated significantly lower predictive power compared to those incorporating both time intervals (p < 0.05). Conclusion: Multi-parameter data from the SBT and post-SBT rest period provide dynamic insights into extubation readiness. The developed machine-learning model demonstrates modest improvement over traditional metrics such as RSBI and may serve as a complementary tool to support extubation decision-making.