Predictive value of extubation failure by decrease in central venous oxygen saturation: A systematic review and meta-analysis

BACKGROUND: The predictive power of extubation failure diagnosed by decrease in central venous oxygen saturation (ΔScvO2) varies by studies. Here we summarized the diagnostic value of extubation failure tested by ΔScvO2. METHODS: A comprehensive online search was performed to select potentially eligible studies that evaluated the predictive power of extubation failure tested by ΔScvO2. A manual search was also performed to identify additional studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) to evaluate the predictive power of extubation failure. RESULTS: Overall, five studies including 353 patients were included in this review, of whom 105 (30%) were extubation failure. The cutoff values of ΔScvO2 varied across studies, ranging from 3.8% to 5.4%. Heterogeneity between studies was assessed with an overall Q = 0.007, I(2) = 0%, and P = 0.498. The pooled sensitivity and specificity for the overall population were 0.83 (95% CI: 0.74–0.90) and 0.88 (95% CI: 0.83–0.92), respectively. The pooled positive LR and negative LR were 7.2 (95%CI: 4.6–11.2) and 0.19 (95%CI: 0.12–0.31), respectively. The DOR was 38 (95% CI: 17–86). Overall, the pooled AUROC was 0.92 (95% CI: 0.90–0.94). CONCLUSIONS: The ΔScvO2 performed well in predicting extubation failure in adult mechanical ventilation patients. Further studies with a larger data set and well-designed models are required to confirm the diagnostic accuracy and utility of ScvO2 in predicting extubation outcomes in mechanical ventilation patients.