Lung ultrasound score versus HACOR score as a predictor for weaning outcome in patients at high risk for extubation failure.

Abstract

Background: Pulmonary complications from mechanical ventilation are a significant concern in intensive care. Reducing the duration of respiratory support is vital to minimize these risks. Extubation, the final step in the weaning process, is critical. Most weaning indices rely on complex ventilatory parameters. This study aimed to evaluate the utility of the heart rate, acidosis, Glasgow Coma Scale, oxygenation, respiratory rate (HACOR) score, and Lung Ultrasound Score (LUS) as predictors of weaning outcomes in the intensive care unit.

Methods: This prospective observational study was conducted in the Department of Critical Care Medicine at Sri Ramachandra Institute of Higher Education and Research, involving 100 patients aged 18 years and above. Both the HACOR score and LUS were assessed at the 30th minute during a 60-minute spontaneous breathing trial (SBT).

Results: Of the 100 patients, 65 (65%) were successfully weaned, while 35 (35%) experienced weaning failure. The median HACOR score was 3 (interquartile range: 0-3) in the successful group and 6 (IQR: 5-8) in the failed group. The median LUS was 10 (IQR: 8-10) in the successful group and 16 (IQR: 13-16) in the failed group. A HACOR score ≥5 predicted weaning failure with a sensitivity of 87.7%, specificity of 77.1%, and area under the curve of 0.824. The LUS had an area under curve of 0.831, sensitivity of 86.2%, specificity of 80% at a threshold of ≥13 for failure.

Conclusion: A HACOR score of ≥5 and a Lung Ultrasound Score of ≥13 are excellent predictors of weaning failure and can be incorporated into ICU weaning strategies.