{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T07:59:25Z","timestamp":1777795165522,"version":"3.51.4"},"reference-count":33,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"unspecified","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100019065","name":"Tianjin Science and Technology Plan Project","doi-asserted-by":"crossref","award":["18ZXDBSY00100"],"award-info":[{"award-number":["18ZXDBSY00100"]}],"id":[{"id":"10.13039\/501100019065","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100019065","name":"Tianjin Science and Technology Plan Project","doi-asserted-by":"crossref","award":["21JCYBJC01200"],"award-info":[{"award-number":["21JCYBJC01200"]}],"id":[{"id":"10.13039\/501100019065","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Research Project on the Integration of Traditional Chinese Medicine and Western Medicine by Tianjin Municipal Health Commission","award":["2023220"],"award-info":[{"award-number":["2023220"]}]},{"name":"Research Project on the Integration of Traditional Chinese Medicine and Western Medicine by Tianjin Municipal Health Commission","award":["2023221"],"award-info":[{"award-number":["2023221"]}]},{"name":"Tianjin Key Medical Discipline(Specialty) Construction project","award":["TJYXZDXK-035A"],"award-info":[{"award-number":["TJYXZDXK-035A"]}]},{"name":"Key Research Projects in Traditional Chinese Medicine in Tianjin","award":["2025019"],"award-info":[{"award-number":["2025019"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,4,27]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to establish a diagnostic system using retrospective data to predict difficult wean from mechanical ventilation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A multicentre retrospective study<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Five tertiary hospitals from China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Critically ill patients received mechanical ventilation between January 2018 and December 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary endpoint was success weaning from mechanical ventilation (&gt;48\u2009hours), reintubation or death, whichever occurred first.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1365 initially screened patients, 703 patients (median age: 69 years; 63.02% male) were included. From 42 factors, 22 (p\u22640.10) were identified for multivariate analysis. Subsequently, the lung injury score, brain natriuretic peptide level at 24\u2009hours, 24\u2009hour fluid balance, use of dexmedetomidine, spontaneous breathing trial (continuous positive airway pressure vs other) and endotracheal tube reinsertion were included in the predictive model. The area under the curve value was 0.8888 (95% CI: 0.8382, 0.9394). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, likelihood ratio (LR)+ and LR\u2212 were 0.7559, 0.875, 0.9746, 0.3608, 0.7721, 6.0743 and 0.279, respectively. We established a nomogram model based on the optimal model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A model with six factors was established to predict difficult wean from mechanical ventilation in critically ill patients. However, the model should be verified in future well-designed studies before being extended to other populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ChiCTR1900021432. Registered on February 21, 2019; Post-results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-097419","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:55:23Z","timestamp":1747356923000},"page":"e097419","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Risk prediction model for difficulty in weaning from mechanical ventilation in critically ill patients: results from a multicentre retrospective study"],"prefix":"10.1136","volume":"15","author":[{"given":"Chengfen","family":"Yin","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin, China"},{"name":"Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China"},{"name":"Artificial Cell Engineering Technology Research Center, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6273-5876","authenticated-orcid":false,"given":"Lei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin, China"},{"name":"Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China"},{"name":"Artificial Cell Engineering Technology Research Center, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenxiong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quansheng","family":"Du","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hebei General Hospital, Shijiazhuang, Hebei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongzhi","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Respiratory, Haihe Hospital, Tianjin University, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Dou","sequence":"additional","affiliation":[{"name":"TianJin First Center Hospital, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Limin","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin, China"},{"name":"Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China"},{"name":"Artificial Cell Engineering Technology Research Center, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xing","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin, China"},{"name":"Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China"},{"name":"Artificial Cell Engineering Technology Research Center, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiya","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin, China"},{"name":"Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China"},{"name":"Artificial Cell Engineering Technology Research Center, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunfeng","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin, China"},{"name":"Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China"},{"name":"Artificial Cell Engineering Technology Research Center, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"2025121513591137000_15.5.e097419.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuropsychologia.2015.04.008"},{"key":"2025121513591137000_15.5.e097419.2","doi-asserted-by":"publisher","DOI":"10.1186\/cc2927"},{"key":"2025121513591137000_15.5.e097419.3","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-022-04028-7","article-title":"Respiratory distress observation scales to predict weaning outcome","volume":"26","author":"Decav\u00e8le","year":"2022","journal-title":"Crit Care"},{"key":"2025121513591137000_15.5.e097419.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-021-03802-3","article-title":"Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis","volume":"25","author":"Torrini","year":"2021","journal-title":"Crit Care"},{"key":"2025121513591137000_15.5.e097419.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-021-03550-4","article-title":"Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis","volume":"25","author":"Yasuda","year":"2021","journal-title":"Crit Care"},{"key":"2025121513591137000_15.5.e097419.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-021-06383-2","article-title":"The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90\u2009days and 180\u2009days","volume":"21","author":"Luo","year":"2021","journal-title":"BMC Infect Dis"},{"key":"2025121513591137000_15.5.e097419.7","doi-asserted-by":"crossref","DOI":"10.1186\/s40248-018-0118-7","article-title":"The patient needing prolonged mechanical ventilation: a narrative review","volume":"13","author":"Ambrosino","year":"2018","journal-title":"Multidiscip Respir Med"},{"key":"2025121513591137000_15.5.e097419.8","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200207000-00021"},{"key":"2025121513591137000_15.5.e097419.9","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000014841","article-title":"Outcomes of unplanned extubation in ordinary ward are similar to those in intensive care unit: A STROBE-compliant case-control study","volume":"98","author":"Lin","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"2025121513591137000_15.5.e097419.10","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.08656"},{"key":"2025121513591137000_15.5.e097419.11","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.158.6.9712135"},{"key":"2025121513591137000_15.5.e097419.12","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201208-1523CI"},{"key":"2025121513591137000_15.5.e097419.13","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-47452-7","article-title":"Defining predictors for successful mechanical ventilation weaning, using a data-mining process and artificial intelligence","volume":"13","author":"Menguy","year":"2023","journal-title":"Sci Rep"},{"key":"2025121513591137000_15.5.e097419.14","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.hrtlng.2022.11.005","article-title":"Developing an explainable machine learning model to predict the mechanical ventilation duration of patients with ARDS in intensive care units","volume":"58","author":"Wang","year":"2023","journal-title":"Heart Lung"},{"key":"2025121513591137000_15.5.e097419.15","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-33159-2","article-title":"Prediction prolonged mechanical ventilation in trauma patients of the intensive care unit according to initial medical factors: a machine learning approach","volume":"13","author":"Vali","year":"2023","journal-title":"Sci Rep"},{"key":"2025121513591137000_15.5.e097419.16","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-011-9528-5"},{"key":"2025121513591137000_15.5.e097419.17","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182946649"},{"key":"2025121513591137000_15.5.e097419.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-023-02039-7","article-title":"NT-proBNP change is useful for predicting weaning failure from invasive mechanical ventilation among postsurgical patients: a retrospective, observational cohort study","volume":"23","author":"Zheng","year":"2023","journal-title":"BMC Anesthesiol"},{"key":"2025121513591137000_15.5.e097419.19","doi-asserted-by":"crossref","first-page":"33","DOI":"10.6061\/clinics\/2013(01)OA05","article-title":"High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery","volume":"68","author":"Lara","year":"2013","journal-title":"Clinics (Sao Paulo)"},{"key":"2025121513591137000_15.5.e097419.20","doi-asserted-by":"crossref","DOI":"10.1177\/1470320321999497","article-title":"The predictive value of brain natriuretic peptide or N-terminal pro-brain natriuretic peptide for weaning outcome in mechanical ventilation patients: Evidence from SROC","volume":"22","author":"Liu","year":"2021","journal-title":"J Renin Angiotensin Aldosterone Syst"},{"key":"2025121513591137000_15.5.e097419.21","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2010.51.2.151"},{"key":"2025121513591137000_15.5.e097419.22","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201210-1770ED"},{"key":"2025121513591137000_15.5.e097419.23","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/0885066619887694","article-title":"Association of Body Weight Change and Fluid Balance With Extubation Failure in Intensive Care Unit Patients: A Single-Center Observational Study","volume":"36","author":"Maezawa","year":"2021","journal-title":"J Intensive Care Med"},{"key":"2025121513591137000_15.5.e097419.24","doi-asserted-by":"crossref","first-page":"767","DOI":"10.4103\/ijccm.IJCCM_216_18","article-title":"Cumulative Fluid Balance and Outcome of Extubation: A Prospective Observational Study from a General Intensive Care Unit","volume":"22","author":"Ghosh","year":"2018","journal-title":"Indian J Crit Care Med"},{"key":"2025121513591137000_15.5.e097419.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-022-01708-3","article-title":"Association between fluid intake and extubation failure in intensive care unit patients with negative fluid balance: a retrospective observational study","volume":"22","author":"Li","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"2025121513591137000_15.5.e097419.26","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-005-2801-3"},{"key":"2025121513591137000_15.5.e097419.27","doi-asserted-by":"publisher","DOI":"10.1378\/chest.130.6.1664"},{"key":"2025121513591137000_15.5.e097419.28","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1001\/jama.2019.7234","article-title":"Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial","volume":"321","author":"Subir\u00e0","year":"2019","journal-title":"JAMA"},{"key":"2025121513591137000_15.5.e097419.29","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.03037"},{"key":"2025121513591137000_15.5.e097419.30","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201201-0050ED"},{"key":"2025121513591137000_15.5.e097419.31","doi-asserted-by":"crossref","unstructured":"Cooper RM . Extubation and changing endotracheal tubes. Benumof\u2019s Airway Management, 2007:1146\u201380.","DOI":"10.1016\/B978-032302233-0.50056-1"},{"key":"2025121513591137000_15.5.e097419.32","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1097\/CCM.0000000000000748","article-title":"Risk factors for and prediction by caregivers of extubation failure in ICU patients: a prospective study","volume":"43","author":"Thille","year":"2015","journal-title":"Crit Care Med"},{"key":"2025121513591137000_15.5.e097419.33","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0277915","article-title":"Incidence of extubation failure and its predictors among adult patients in intensive care unit of low-resource setting: A prospective observational study","volume":"17","author":"Kifle","year":"2022","journal-title":"PLoS One"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-097419","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T21:59:20Z","timestamp":1765835960000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-097419"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":33,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,15]]},"published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1136\/bmjopen-2024-097419"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-097419","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}