ArticleAcute and critical care2026
Minimum observation time to determine ventilator liberation success and its associated factors in tracheostomized patients in intensive and high-care units in Japan: a single-center retrospective study.
Article in Acute and critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTime-based criteria for mechanical ventilation (MV) liberation in tracheostomized patients undergoing T-tube trials with ventilator discontinuation are inconsistent. We aimed to define the minimum post-liberation observation time and identify factors associated with successful liberation.
methodsThis single-center retrospective cohort study included adults with tracheostomy who received MV in the intensive care unit and high-care unit of a Japanese hospital from November 14, 2019, to August 31, 2024. We measured maximum endurance time (MET) without MV, MV liberation success, and the shortest MET when success first exceeded 80% (mini-MET). Time to miniMET was assessed by Kaplan-Meier median survival time (MST), and competing risk analysis treating in-hospital death as a competing event was performed. Predictors were screened by univariate C-index, and survival tree cutoffs were examined using logistic regression sensitivity analyses.
resultsAmong 160 patients, MV liberation success increased with MET from 65% to 94% at 168 hours. The MST to achieve the mini-MET, which was identified as 4 hours, was 7 days (95% CI, 5-10 days). Mechanical power normalized by dynamic compliance (MPCdyn) ≤454.72 J/min and albumin >2.3 g/dl were associated with success. MST was 3 days when both were satisfied. In a covariate-adjusted model, low MPCdyn plus high albumin remained associated with success. Replacing MPCdyn with driving pressure yielded similar findings.
conclusionsFour hours may be a practical minimum post-liberation observation time, whereas 48 hours may be a conservative option. Stratification by MPCdyn or driving pressure plus albumin can support consistent MV liberation decisions after tracheostomy.
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