Physiotherapist prediction of extubation outcome in the adult intensive care unit.
Gabriella Cork, Luigi Camporota, Leyla Osman and 1 others
PMID 31237395WHAT IT FOUND
Specialist physiotherapists correctly identified every patient who failed extubation in this ICU cohort.
Their clinical judgment was more sensitive than a statistical model or nonspecialist staff. High-risk stratification should trigger multidisciplinary planning for supported extubation rather than delaying the procedure.
Key findings
01Specialist physiotherapists achieved 100% sensitivity in detecting extubation failure, meaning all patients who failed had been flagged as high risk.
02Patients classified as high risk by physiotherapists were four times more likely to fail extubation than those classified as moderate or low risk.
03A statistical prediction model based on nine variables had higher specificity but lower overall sensitivity than specialist physiotherapists.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a service evaluation, not a randomised controlled trial, so causality cannot be inferred. There was potential selection bias: patients deemed low risk by consultants may have been extubated without a physiotherapy assessment, or assessments may have been requested specifically for higher-risk patients. The study did not control for post-extubation support provided by physiotherapists, which may have prevented failure in some high-risk patients (creating false positives). The sample size was small (68 subjects), and the results come from a single centre with a specific case mix. Individual physiological measures (like cough strength or inspiratory pressure) were not significantly associated with failure, suggesting the predictive value lies in holistic clinical judgment rather than isolated metrics.
Declared interests
The authors declared no financial or other conflicts of interest.
The easy way to misread this
Do not interpret high-risk stratification as a reason to delay extubation. The study suggests that identifying high risk should prompt proactive support (like non-invasive ventilation) to enable successful extubation, rather than keeping the patient intubated.