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VOLUME 26 , ISSUE 8 ( August, 2022 ) > List of Articles

Original Article

Utility of the One-time HACOR Score as a Predictor of Weaning Failure from Mechanical Ventilation: A Prospective Observational Study

Shreya Das Adhikari, Shwethapriya Rao

Keywords : Failed weaning, HACOR score, Successful weaning

Citation Information : Adhikari SD, Rao S. Utility of the One-time HACOR Score as a Predictor of Weaning Failure from Mechanical Ventilation: A Prospective Observational Study. Indian J Crit Care Med 2022; 26 (8):900-905.

DOI: 10.5005/jp-journals-10071-24280

License: CC BY-NC 4.0

Published Online: 30-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: To determine the utility of the HACOR score in predicting weaning failure in resource-limited settings. Objectives: The primary objective was to determine a cut-off value of the HACOR score, sensitivity, and specificity to predict failed weaning. The secondary objective was to determine which out of five components of the score was significantly different between the successful weaning and the failed weaning groups. Introduction: Most weaning indices are either inaccurate or are dependent on complex ventilatory parameters, which are difficult to measure in resource-limited settings. This study aimed to determine the utility of the HACOR score consisting of heart rate, acidosis, consciousness level, oxygenation, and respiratory rate as a predictor of weaning in the intensive care unit. Materials and methods: It was a prospective observational study on 120 patients between 18 and 90 years. The HACOR score was evaluated at 30 minutes of spontaneous breathing trial (SBT). The total duration of SBT was 120 minutes. Results: Out of 120 patients, 83 (69.2%) had successful weaning, whereas 37 (30.8%) had weaning failure. The median and interquartile range (IQR) of the HACOR score in the successful weaning group was 2 (0–3) and 6 (5–8) in the failed weaning group (p-value <0.001). There was a significant difference in each of the five components of the HACOR score between the successful and failed weaning groups (p <0.05). HACOR score ≥5 predicted failed weaning, sensitivity 83.8%, specificity 96.4%, area under the curve (AUC) 0.950, and 95% confidence interval (CI) [0.907–0.993], p <0.001. Multivariable logistic regression analysis showed that HACOR score ≥5 is an independent predictor of weaning failure [p <0.001, 95% CI (1.9–4.2), adjusted odds ratio 2.82]. Conclusion: A HACOR score ≥5 is an excellent predictor of weaning failure. This score may be useful as a weaning strategy in the intensive care unit.

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  1. Pastores SM, Halpern NA, Oropello JM, Kvetan V. Intensivist workforce in the United States: the crisis is real, not imagined. Am J Respir Crit Care Med 2015;191(6):718–719. DOI: 10.1164/rccm.201501-0079LE.
  2. Nemer SN, Barbas CS, Caldeira JB, Cárias TC, Santos RG, Almeida LC, et al. A new integrative weaning index of discontinuation from mechanical ventilation. Crit Care 2009;13(5):R152. DOI: 10.1186/cc8051.
  3. Duan J, Han X, Bai L, Zhou L, Huang S. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med 2017;43(2):192–199. DOI: 10.1007/s00134-016-4601-3.
  4. John JPJ, Johnson S, Shenoy A. Comparison of five weaning indices in predicting successful weaning from mechanical ventilation. Ind J Resp Care 2013;2(2):299–306.
  5. Seymour CW, Christie JD, Gaughan C, Fuchs BD. Measurement of a baseline minute ventilation for the calculation of minute ventilation recovery time: is a subjective method reliable? Respir Care 2005;50(4):468–472. PMID: 15807909.
  6. Karthika M, Al Enezi FA, Pillai LV, Arabi YM. Rapid shallow breathing index. Ann Thorac Med 2016;11(3):167–176. DOI: 10.4103/1817-1737.176876.
  7. Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure–a structured approach. Crit Care 2010;14(6):245. DOI: 10.1186/cc9296.
  8. Meredith W, Rutledge R, Fakhry SM, Emery S, Kromhout-Schiro S. The conundrum of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores. J Trauma 1998;44(5):839–844. DOI: 10.1097/00005373-199805000-00016.
  9. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324(21):1445–1450. DOI: 10.1056/NEJM199105233242101.
  10. Mowafy SMS, Abdelgalel EF. Diaphragmatic rapid shallow breathing index for predicting weaning outcome from mechanical ventilation: comparison with traditional rapid shallow breathing index. Egypt J Anaesth 2019;35(1):9–17. DOI: 10.1016/j. egja.2018.10.003.
  11. Lee KH, Hui KP, Chan TB, Tan WC, Lim TK. Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome. Chest 1994;105(2):540–543. DOI: 10.1378/chest.105.2.540.
  12. Segal LN, Oei E, Oppenheimer BW, Goldring RM, Bustami RT, Ruggiero S, et al. Evolution of pattern of breathing during a spontaneous breathing trial predicts successful extubation. Intensive Care Med 2010;36(3):487–495. DOI: 10.1007/s00134-009-1735-6.
  13. Kulkarni AP, Agarwal V. Extubation failure in intensive care unit: predictors and management. Indian J Crit Care Med 2008;12(1):1–9. DOI: 10.4103/0972-5229.40942.
  14. Liang G, Liu T, Zeng Y, Shi Y, Yang W, Yang Y, et al. Characteristics of subjects who failed a 120-minute spontaneous breathing trial. Respir Care 2018;63(4):388–394. DOI: 10.4187/respcare.05820.
  15. Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med 2011;39(12):2612–2618. DOI: 10.1097/CCM.0b013e3182282a5a.
  16. Banerjee A, Mehrotra G. Comparison of lung ultrasound-based weaning indices with rapid shallow breathing index: are they helpful? Indian J Crit Care Med 2018;22(6):435–440. DOI: 10.4103/ijccm.IJCCM_331_17.
  17. DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax 2014;69(5):423–427. DOI: 10.1136/thoraxjnl-2013-204111.
  18. Soliman SB, Ragab F, Soliman RA, Gaber A, Kamal A. Chest ultrasound in predication of weaning failure. Open Access Maced J Med Sci 2019;7(7):1143–1147. DOI: 10.3889/oamjms.2019.277.
  19. Shah S, Bellows BA, Adedipe AA, Totten JE, Backlund BH, Sajed D. Perceived barriers in the use of ultrasound in developing countries. Crit Ultrasound J 2015;7(1):28. DOI: 10.1186/s13089-015- 0028-2.
  20. Paladini D. Sonography in obese and overweight pregnant women: clinical, medicolegal and technical issues. Ultrasound Obstet Gynecol 2009;33(6):720–729. DOI: 10.1002/uog.6393.
  21. Gardelli G, Feletti F, Nanni A, Mughetti M, Piraccini A, Zompatori M. Chest ultrasonography in the ICU. Respir Care 2012;57(5):773–781. DOI: 10.4187/respcare.01743.
  22. Routsi C, Stanopoulos I, Kokkoris S, Sideris A, Zakynthinos S. Weaning failure of cardiovascular origin: how to suspect, detect and treat-a review of the literature. Ann Intensive Care 2019;9(1):6. DOI: 10.1186/s13613-019-0481-3.
  23. Jonville S, Delpech N, Denjean A. Contribution of respiratory acidosis to diaphragmatic fatigue at exercise. Eur Respir J 2002;19(6): 1079–1086. DOI: 10.1183/09031936.02.00268202.
  24. Dres M, Goligher EC, Heunks LMA, Brochard LJ. Critical illness-associated diaphragm weakness. Intensive Care Med 2017;43(10): 1441–1452. DOI: 10.1007/s00134-017-4928-4.
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