Reliability of airway occlusion pressure (P0.1) in predicting extubation failure in critically ill patients

Jihad Mallat; Nicolas Storme; Mohamed Askalany; Mohamed Helal; Mehraj Ud Din; Sujay Samanta; Sukhen Samanta; Fadi Hamed; Unmesh Edke; Tiago Carvalho; Bruno De Oliveira; Hussam Elkambergy; Jamil Dibu; Ahmad Bayrlee; Haamid Siddique; Rehan Haque; Nahla Aljaberi; Samer Shoshan; Dnyaneshwar Munde; Mathieu Guilbart; Ujwal Dhundi; Noora Alhajri; Maryam Babar; Ahmed Taha; Mehdi Belfegas; Ayo Mandi; Umar Khan; Ihab Ahmed; Tariq Omer; Yeldho Varghese; Praveen Ghisulal; Mathieu Metzelard; Vivek Kakar; Arvin Charles; Muhammed Kacherintavida; Cheikh El Mali; Christophe Beyls; Sridhar Venkatarmireddy; Rahul Amte; Mohammed Aljasmi; Baraa Abduljawad; Khaled Ismail; Yazine Mahjoub; Osama Abou Arab

doi:10.1016/j.jointm.2026.01.001

Reliability of airway occlusion pressure (P0.1) in predicting extubation failure in critically ill patients

Jihad Mallat
, Nicolas Storme
, Mohamed Askalany
, Mohamed Helal
, Mehraj Ud Din
, Sujay Samanta
, Sukhen Samanta
, Fadi Hamed
, Unmesh Edke
, Tiago Carvalho
, Bruno De Oliveira
, Hussam Elkambergy
, Jamil Dibu
, Ahmad Bayrlee
, Haamid Siddique
, Rehan Haque
, Nahla Aljaberi
, Samer Shoshan
, Dnyaneshwar Munde
, Mathieu Guilbart

Ujwal Dhundi, Noora Alhajri, Maryam Babar, Ahmed Taha, Mehdi Belfegas, Ayo Mandi, Umar Khan, Ihab Ahmed, Tariq Omer, Yeldho Varghese, Praveen Ghisulal, Mathieu Metzelard, Vivek Kakar, Arvin Charles, Muhammed Kacherintavida, Cheikh El Mali, Christophe Beyls, Sridhar Venkatarmireddy, Rahul Amte, Mohammed Aljasmi, Baraa Abduljawad, Khaled Ismail, Yazine Mahjoub, Osama Abou Arab

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
University of Banja Luka
Service de neurologie
Cleveland Clinic Abu Dhabi

Research output: Contribution to journal › Article › peer-review

Abstract

BackgroundThe airway occlusion pressure (P0.1) reflects the central respiratory drive and correlates with patients’ inspiratory effort. This study aimed to assess whether changes in P0.1 (ΔP0.1) during the spontaneous breathing trial (SBT), as well as SBT-induced changes in the products of P0.1 and the rapid shallow breathing index (RSBI) (Δ(P0.1 × RSBI)) and P0.1 and respiratory rate ((Δ(P0.1 × RR)), can predict extubation failure (EF) in critically ill patients.MethodsIn this bicentric prospective study, we enrolled 114 intensive care unit (ICU) patients who had been mechanically ventilated for more than 48 h and successfully tolerated a 30-min SBT on pressure support ventilation. Respiratory variables, including P0.1 and RSBI, as well as hemodynamic parameters, were recorded within 5 min of SBT initiation and at its completion. EF was defined as the need for reintubation and resumption of mechanical ventilation within 7 days. Areas under the receiver operating characteristic curves (AUCs) were calculated for both relative and absolute ΔP0.1, Δ(P0.1×RSBI), and Δ(P0.1×RR).Results Among the 114 patients, 23 (20.2%) experienced EF. At baseline, P0.1, P0.1×RR, and P0.1×RSBI values did not differ significantly between the success and failure groups. During the SBT, P0.1, P0.1×RR, and P0.1 × RSBI increased significantly in the failure group, while remaining unchanged in the success group. Absolute ΔP0.1 demonstrated poor predictive performance for EF, with AUC of 0.69 (P=0.005). In contrast, absolute Δ(P0.1×RSBI), and absolute Δ(P0.1 × RR) showed moderate predictive ability, with AUCs of 0.79 (P<0.001) and 0.76 (P<0.001), respectively. In the multivariable logistic regression analyses, the absolute, but not the relative, ΔP0.1, Δ(P0.1×RR), and Δ(P0.1×RSBI) remained independently associated with EF after adjustment for potential confounders.ConclusionsVariations in P0.1 and in the combined parameters P0.1×RSBI and P0.1×RR during the SBT provided limited value for predicting EF in critically ill patients.

Original language	English
Journal	Journal of Intensive Medicine
DOIs	https://doi.org/10.1016/j.jointm.2026.01.001
State	Accepted/In press - 2026

Keywords

Airway occlusion pressure
Extubation failure
Inspiratory effort
Respiratory drive
Shallow breath index
Spontaneous breathing trial
Work of breathing

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10.1016/j.jointm.2026.01.001

Cite this

Mallat, J., Storme, N., Askalany, M., Helal, M., Din, M. U., Samanta, S., Samanta, S., Hamed, F., Edke, U., Carvalho, T., De Oliveira, B., Elkambergy, H., Dibu, J., Bayrlee, A., Siddique, H., Haque, R., Aljaberi, N., Shoshan, S., Munde, D., ... Arab, O. A. (Accepted/In press). Reliability of airway occlusion pressure (P0.1) in predicting extubation failure in critically ill patients. Journal of Intensive Medicine. https://doi.org/10.1016/j.jointm.2026.01.001

@article{2e76533315814e96b482944437c9ce80,

title = "Reliability of airway occlusion pressure (P0.1) in predicting extubation failure in critically ill patients",

abstract = "BackgroundThe airway occlusion pressure (P0.1) reflects the central respiratory drive and correlates with patients{\textquoteright} inspiratory effort. This study aimed to assess whether changes in P0.1 (ΔP0.1) during the spontaneous breathing trial (SBT), as well as SBT-induced changes in the products of P0.1 and the rapid shallow breathing index (RSBI) (Δ(P0.1 × RSBI)) and P0.1 and respiratory rate ((Δ(P0.1 × RR)), can predict extubation failure (EF) in critically ill patients.MethodsIn this bicentric prospective study, we enrolled 114 intensive care unit (ICU) patients who had been mechanically ventilated for more than 48 h and successfully tolerated a 30-min SBT on pressure support ventilation. Respiratory variables, including P0.1 and RSBI, as well as hemodynamic parameters, were recorded within 5 min of SBT initiation and at its completion. EF was defined as the need for reintubation and resumption of mechanical ventilation within 7 days. Areas under the receiver operating characteristic curves (AUCs) were calculated for both relative and absolute ΔP0.1, Δ(P0.1×RSBI), and Δ(P0.1×RR).Results Among the 114 patients, 23 (20.2\%) experienced EF. At baseline, P0.1, P0.1×RR, and P0.1×RSBI values did not differ significantly between the success and failure groups. During the SBT, P0.1, P0.1×RR, and P0.1 × RSBI increased significantly in the failure group, while remaining unchanged in the success group. Absolute ΔP0.1 demonstrated poor predictive performance for EF, with AUC of 0.69 (P=0.005). In contrast, absolute Δ(P0.1×RSBI), and absolute Δ(P0.1 × RR) showed moderate predictive ability, with AUCs of 0.79 (P<0.001) and 0.76 (P<0.001), respectively. In the multivariable logistic regression analyses, the absolute, but not the relative, ΔP0.1, Δ(P0.1×RR), and Δ(P0.1×RSBI) remained independently associated with EF after adjustment for potential confounders.ConclusionsVariations in P0.1 and in the combined parameters P0.1×RSBI and P0.1×RR during the SBT provided limited value for predicting EF in critically ill patients.",

keywords = "Airway occlusion pressure, Extubation failure, Inspiratory effort, Respiratory drive, Shallow breath index, Spontaneous breathing trial, Work of breathing",

author = "Jihad Mallat and Nicolas Storme and Mohamed Askalany and Mohamed Helal and Din, \{Mehraj Ud\} and Sujay Samanta and Sukhen Samanta and Fadi Hamed and Unmesh Edke and Tiago Carvalho and \{De Oliveira\}, Bruno and Hussam Elkambergy and Jamil Dibu and Ahmad Bayrlee and Haamid Siddique and Rehan Haque and Nahla Aljaberi and Samer Shoshan and Dnyaneshwar Munde and Mathieu Guilbart and Ujwal Dhundi and Noora Alhajri and Maryam Babar and Ahmed Taha and Mehdi Belfegas and Ayo Mandi and Umar Khan and Ihab Ahmed and Tariq Omer and Yeldho Varghese and Praveen Ghisulal and Mathieu Metzelard and Vivek Kakar and Arvin Charles and Muhammed Kacherintavida and Mali, \{Cheikh El\} and Christophe Beyls and Sridhar Venkatarmireddy and Rahul Amte and Mohammed Aljasmi and Baraa Abduljawad and Khaled Ismail and Yazine Mahjoub and Arab, \{Osama Abou\}",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s). Published by Elsevier B.V. on behalf of Chinese Medical Association. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/",

year = "2026",

doi = "10.1016/j.jointm.2026.01.001",

language = "English",

journal = "Journal of Intensive Medicine",

issn = "2097-0250",

publisher = "Chinese Medical Association",

}

Mallat, J, Storme, N, Askalany, M, Helal, M, Din, MU, Samanta, S, Samanta, S, Hamed, F, Edke, U, Carvalho, T, De Oliveira, B , Elkambergy, H , Dibu, J , Bayrlee, A , Siddique, H , Haque, R, Aljaberi, N, Shoshan, S, Munde, D, Guilbart, M, Dhundi, U, Alhajri, N, Babar, M, Taha, A, Belfegas, M, Mandi, A, Khan, U, Ahmed, I, Omer, T, Varghese, Y, Ghisulal, P, Metzelard, M, Kakar, V, Charles, A, Kacherintavida, M, Mali, CE, Beyls, C, Venkatarmireddy, S, Amte, R, Aljasmi, M, Abduljawad, B, Ismail, K, Mahjoub, Y & Arab, OA 2026, 'Reliability of airway occlusion pressure (P0.1) in predicting extubation failure in critically ill patients', Journal of Intensive Medicine. https://doi.org/10.1016/j.jointm.2026.01.001

TY - JOUR

T1 - Reliability of airway occlusion pressure (P0.1) in predicting extubation failure in critically ill patients

AU - Mallat, Jihad

AU - Storme, Nicolas

AU - Askalany, Mohamed

AU - Helal, Mohamed

AU - Din, Mehraj Ud

AU - Samanta, Sujay

AU - Samanta, Sukhen

AU - Hamed, Fadi

AU - Edke, Unmesh

AU - Carvalho, Tiago

AU - De Oliveira, Bruno

AU - Elkambergy, Hussam

AU - Dibu, Jamil

AU - Bayrlee, Ahmad

AU - Siddique, Haamid

AU - Haque, Rehan

AU - Aljaberi, Nahla

AU - Shoshan, Samer

AU - Munde, Dnyaneshwar

AU - Guilbart, Mathieu

AU - Dhundi, Ujwal

AU - Alhajri, Noora

AU - Babar, Maryam

AU - Taha, Ahmed

AU - Belfegas, Mehdi

AU - Mandi, Ayo

AU - Khan, Umar

AU - Ahmed, Ihab

AU - Omer, Tariq

AU - Varghese, Yeldho

AU - Ghisulal, Praveen

AU - Metzelard, Mathieu

AU - Kakar, Vivek

AU - Charles, Arvin

AU - Kacherintavida, Muhammed

AU - Mali, Cheikh El

AU - Beyls, Christophe

AU - Venkatarmireddy, Sridhar

AU - Amte, Rahul

AU - Aljasmi, Mohammed

AU - Abduljawad, Baraa

AU - Ismail, Khaled

AU - Mahjoub, Yazine

AU - Arab, Osama Abou

N1 - Publisher Copyright: © 2026 The Author(s). Published by Elsevier B.V. on behalf of Chinese Medical Association. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/

PY - 2026

Y1 - 2026

N2 - BackgroundThe airway occlusion pressure (P0.1) reflects the central respiratory drive and correlates with patients’ inspiratory effort. This study aimed to assess whether changes in P0.1 (ΔP0.1) during the spontaneous breathing trial (SBT), as well as SBT-induced changes in the products of P0.1 and the rapid shallow breathing index (RSBI) (Δ(P0.1 × RSBI)) and P0.1 and respiratory rate ((Δ(P0.1 × RR)), can predict extubation failure (EF) in critically ill patients.MethodsIn this bicentric prospective study, we enrolled 114 intensive care unit (ICU) patients who had been mechanically ventilated for more than 48 h and successfully tolerated a 30-min SBT on pressure support ventilation. Respiratory variables, including P0.1 and RSBI, as well as hemodynamic parameters, were recorded within 5 min of SBT initiation and at its completion. EF was defined as the need for reintubation and resumption of mechanical ventilation within 7 days. Areas under the receiver operating characteristic curves (AUCs) were calculated for both relative and absolute ΔP0.1, Δ(P0.1×RSBI), and Δ(P0.1×RR).Results Among the 114 patients, 23 (20.2%) experienced EF. At baseline, P0.1, P0.1×RR, and P0.1×RSBI values did not differ significantly between the success and failure groups. During the SBT, P0.1, P0.1×RR, and P0.1 × RSBI increased significantly in the failure group, while remaining unchanged in the success group. Absolute ΔP0.1 demonstrated poor predictive performance for EF, with AUC of 0.69 (P=0.005). In contrast, absolute Δ(P0.1×RSBI), and absolute Δ(P0.1 × RR) showed moderate predictive ability, with AUCs of 0.79 (P<0.001) and 0.76 (P<0.001), respectively. In the multivariable logistic regression analyses, the absolute, but not the relative, ΔP0.1, Δ(P0.1×RR), and Δ(P0.1×RSBI) remained independently associated with EF after adjustment for potential confounders.ConclusionsVariations in P0.1 and in the combined parameters P0.1×RSBI and P0.1×RR during the SBT provided limited value for predicting EF in critically ill patients.

AB - BackgroundThe airway occlusion pressure (P0.1) reflects the central respiratory drive and correlates with patients’ inspiratory effort. This study aimed to assess whether changes in P0.1 (ΔP0.1) during the spontaneous breathing trial (SBT), as well as SBT-induced changes in the products of P0.1 and the rapid shallow breathing index (RSBI) (Δ(P0.1 × RSBI)) and P0.1 and respiratory rate ((Δ(P0.1 × RR)), can predict extubation failure (EF) in critically ill patients.MethodsIn this bicentric prospective study, we enrolled 114 intensive care unit (ICU) patients who had been mechanically ventilated for more than 48 h and successfully tolerated a 30-min SBT on pressure support ventilation. Respiratory variables, including P0.1 and RSBI, as well as hemodynamic parameters, were recorded within 5 min of SBT initiation and at its completion. EF was defined as the need for reintubation and resumption of mechanical ventilation within 7 days. Areas under the receiver operating characteristic curves (AUCs) were calculated for both relative and absolute ΔP0.1, Δ(P0.1×RSBI), and Δ(P0.1×RR).Results Among the 114 patients, 23 (20.2%) experienced EF. At baseline, P0.1, P0.1×RR, and P0.1×RSBI values did not differ significantly between the success and failure groups. During the SBT, P0.1, P0.1×RR, and P0.1 × RSBI increased significantly in the failure group, while remaining unchanged in the success group. Absolute ΔP0.1 demonstrated poor predictive performance for EF, with AUC of 0.69 (P=0.005). In contrast, absolute Δ(P0.1×RSBI), and absolute Δ(P0.1 × RR) showed moderate predictive ability, with AUCs of 0.79 (P<0.001) and 0.76 (P<0.001), respectively. In the multivariable logistic regression analyses, the absolute, but not the relative, ΔP0.1, Δ(P0.1×RR), and Δ(P0.1×RSBI) remained independently associated with EF after adjustment for potential confounders.ConclusionsVariations in P0.1 and in the combined parameters P0.1×RSBI and P0.1×RR during the SBT provided limited value for predicting EF in critically ill patients.

KW - Airway occlusion pressure

KW - Extubation failure

KW - Inspiratory effort

KW - Respiratory drive

KW - Shallow breath index

KW - Spontaneous breathing trial

KW - Work of breathing

UR - https://www.scopus.com/pages/publications/105034178600

U2 - 10.1016/j.jointm.2026.01.001

DO - 10.1016/j.jointm.2026.01.001

M3 - Article

AN - SCOPUS:105034178600

SN - 2097-0250

JO - Journal of Intensive Medicine

JF - Journal of Intensive Medicine

ER -

Reliability of airway occlusion pressure (P0.1) in predicting extubation failure in critically ill patients

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