physioscience 2025; 21(S 03): S32
DOI: 10.1055/s-0045-1812425
Abstracts
Poster/Posters

Peripheral muscle strength as a predictor of successfull extubation: a systematic review

Authors

  • F Gabathüler

    1   Physiotherapie Ergotherapie (PEU), Universitätsspital Zürich, Switzerland

  • R Frohofer

    1   Physiotherapie Ergotherapie (PEU), Universitätsspital Zürich, Switzerland
    2   Direktion Forschung & Lehre, Universitätsspital Zürich, Switzerland

  • N Häni

    1   Physiotherapie Ergotherapie (PEU), Universitätsspital Zürich, Switzerland

  • E D de Bruin

    3   Ostschweizer Fachhochschule, Studiengang BSc Physiotherapie, Switzerland
    4   ETH Zürich, Institut für Bewegungswissenschaften und Sport, Switzerland
    5   Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden

  • R Knols

    2   Direktion Forschung & Lehre, Universitätsspital Zürich, Switzerland
    6   ETH Zürich, Institut für Bewegungswissenschaften und Sport, Switzerland
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Background Extubating failure on the Intensive Care Unit occurs in 5–30% of mechanically ventilated patients, with an associated increase in morbidity and mortality. In addition to respiratory factors, peripheral muscle strength, which is measured by physio-and occupational therapists, is increasingly being considered as a potential predictor for successful extubation.

Objective This systematic review evaluated the literature of peripheral muscle strength in adult ICU patients, as a predictor of successful extubation for at least 24 hours without re-intubation and conducted a meta-analysis for those instruments for which sufficient data were available.

Methods A systematic literature search was performed across Medline, EMBASE, Cochrane Library, CINHAL and the PEDro databases by a professional Librarian. The SR was performed according to the PRISMA-Guideline (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two independent reviewers conducted data extraction using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of prognostic Factor studies (Cochrane /CHARMS-PF) and assessed methodological quality using the Quality in Prognosis Studies (QUIPS) tool.

Results Fifteen studies were included in the qualitative synthesis. Average time for mechanical ventilation was 8 days. Succesfull extubation varied between 48 hours and 7 days. The instruments used to predict succesfull extubation were the muscle scale of the Medical Research Council (MRC) and the Jamar dynamometer. Studies that included the MRC showed greater methodological quality compared to the studies that used the JAMAR. Several methodological weaknesses were identified in the included studies, particularly an increased risk of potential confounding factors as age, gender and co-morbidities of the included studies.

Meta-analyses showed significant effects of peripherals muscle strength as a prognostic factor for successful extubation for the MRC (0.92, p<0.001, Z score=4.92,I2=63%) and the Jamar (2.28, p=0.003, Z=3.01, I2=92%).

Discussion Higher values of peripheral muscle strength was associated with a greater success of extubation for ventilated patients on the ICU. However, due to methodological limitations and high heterogeneity of the included studies, the evidence remains inconclusive. Future studies should employ standardised, rigorous research designs and precise control of confounding factors, in order to improve the validity and diagnostic accuracy of the findings.


Publication History

Article published online:
23 October 2025

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