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To compare the diagnostic accuracy of diagnostic predictors of successful weaning in mechanically ventilated adults using network meta-analysis.
Timely liberation from mechanical ventilation is linked to patient outcomes, but the comparative performance of available predictors remains unclear.
A systematic review and network meta-analysis.
We searched PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science from inception to April 8, 2026. Eligible diagnostic accuracy studies evaluated predictors of successful weaning in mechanically ventilated adults. The reference standard was successful liberation or extubation without reintubation or reinstitution of invasive ventilatory support within the study-defined window, most commonly 48 h. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, and certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Twenty-seven studies involving 2938 participants were included in the network meta-analysis and evaluated eight predictors. Four additional eligible studies were not synthesised quantitatively because each evaluated a predictor reported in only one study. The extubation predictive score (ExPreS) was excluded from the connected network because it was evaluated in two single-method studies without head-to-head comparisons, leaving seven predictors. Diaphragmatic excursion, diaphragm thickening fraction, and rapid shallow breathing index formed the core evidence network, and no significant threshold effect was detected. The network meta-analysis showed no clear statistical superiority of any single predictor. Surface under the cumulative ranking curve (SUCRA) rankings suggested that mechanical ventilation duration and diaphragmatic excursion tended to rank higher for overall discrimination and specificity, whereas rapid shallow breathing index and negative inspiratory force ranked higher for sensitivity.
Current evidence does not support a single universally optimal predictor. Diaphragmatic excursion showed a relatively balanced diagnostic profile, but this should be interpreted as a comparative signal rather than definitive superiority because certainty was generally low or very low. Weaning decisions should rely on comprehensive clinical assessment rather than any single index alone.
What problem did the study address? Clinicians caring for mechanically ventilated adults have multiple candidate predictors of weaning success, but their comparative diagnostic accuracy has remained uncertain, making bedside weaning decisions variable and potentially inconsistent.
What were the main findings? Across 27 studies involving 2938 participants included in the network meta-analysis, no single predictor showed clear statistical superiority across all comparisons. Diaphragmatic excursion showed a relatively balanced diagnostic profile, whereas rapid shallow breathing index and negative inspiratory force ranked higher for sensitivity and mechanical ventilation duration ranked higher for overall discrimination and specificity; however, the certainty of evidence was generally low or very low.
Where and on whom will the research have an impact? The findings are most relevant to critical care nurses, intensivists, respiratory therapists and multidisciplinary intensive care unit (ICU) teams caring for mechanically ventilated adults. They support a multidimensional weaning assessment strategy and may improve the safety and consistency of liberation decisions in adult critical care settings.
The findings suggest that no single index should be used in isolation to guide weaning decisions. Diaphragmatic excursion may be a useful adjunct because of its relatively balanced diagnostic profile, but bedside decisions should continue to integrate ultrasound-based measures, conventional respiratory indices, spontaneous breathing trial performance and overall clinical assessment to support safer, more individualised patient care.
This manuscript adhered to relevant Enhancing the QUAlity and Transparency Of health Research (EQUATOR) reporting guidance, specifically the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses incorporating Network Meta-analyses.
Patients, service users, caregivers or members of the public were not involved in the design, conduct, analysis, interpretation or manuscript preparation for this systematic review and network meta-analysis.
The protocol for this systematic review was prospectively registered in PROSPERO (registration number CRD420261362977). Because this study was a systematic review and network meta-analysis rather than a clinical trial, trial registration was not applicable
To compare and rank the effectiveness of various non-pharmacological interventions on depression for community-dwelling individuals with spinal cord injury (SCI).
Depression is a significant and persistent mental health problem among community-dwelling individuals with SCI. There is increasing evidence that non-pharmacological interventions are safe and effective for alleviating depression. However, the efficacy and comparative effectiveness of various non-pharmacological interventions for community-dwelling individuals with SCI remain unclear.
Systematic review and network meta-analysis (NMA) according to PRISMA-NMA guidance.
We included randomized controlled trials (RCTs) of community-dwelling individuals with SCI comparing non-pharmacological interventions versus usual care/waiting list and reporting depressive symptoms using validated scales. China National Knowledge Infrastructure, Wanfang Data, Chinese Biomedical Literature Database, China Science and Technology Journal Database, the Cochrane Library, PubMed, Web of Science, Embase, ProQuest and Scopus were systematically retrieved. Pairwise meta-analyses were performed using Review Manager 5.4.1, and the network meta-analysis was conducted using Stata 15.1.
Thirty-two RCTs involving 2200 participants were identified from database inception to May 2026. Compared with the control group, combination therapy (SMD = −0.86, 95% CI: −1.46 to −0.27), exercise therapy (SMD = −0.66, 95% CI: −1.16 to −0.15), psychological interventions (SMD = −0.41, 95% CI: −0.70 to −0.13) and self-management education (SMD = −0.33, 95% CI: −0.61 to −0.05) showed statistically significant effects, whereas vocational rehabilitation was not (SMD = −0.03, 95% CI: −1.00 to 0.95). Combination therapy had the highest SUCRA (89.1%, mean rank = 1.5), followed by exercise therapy (76.9%, mean rank = 2.2), psychological interventions (55.5%, mean rank = 3.2), self-management education (44.0%, mean rank = 3.8) and vocational rehabilitation (24.7%, mean rank = 4.8).
Combination therapy had the highest ranking probability. However, all comparisons were rated as very low certainty according to CINeMA. The findings should be interpreted with caution.
Community nurses may consider integrating exercise, self-management education and brief psychological support into individualized depression management for individuals with SCI. Support should be tailored according to depressive symptom severity, functional status, secondary complications, patient preferences, safety considerations and available community resources. Nurse-led or nurse-coordinated care may include depressive symptom screening, exercise planning, self-management coaching, motivational interviewing, scheduled follow-up and referral to mental health professionals when indicated.
PROSPERO: CRD42022342155
To investigate the prevalence of rapid response team delays, survival distribution of admission to rapid response team delay and its prognostic factors.
A retrospective single-centre study.
Data on rapid response team activations from 1 January 2018 to 31 December 2022 were retrieved from electronic medical records at a tertiary hospital in Hangzhou, China. All patients who met the eligibility criteria were included. Multivariable Cox regression analysis was conducted to analyse the data.
Out of 636 patients included, 18.4% (117) experienced a delay, with a median (interquartile range) of 8.5 (12) days from admission to rapid response team activation. Six significant prognostic factors were found to be associated with the higher hazard ratio of rapid response team delay, including call time (05:01 PM and 7:59 AM), emergency admission, a higher Modified Early Warning Score, an admission diagnosis of infection, a comorbidity of respiratory failure/Acute Respiratory Distress Syndrome and the absence of lung infection.
The prevalence of rapid response team delays was lower, and the days from admission to rapid response team delay was longer than in previous studies. Healthcare providers are suggested to prioritise the care of high-risk patient groups and provide proactive monitoring to ensure timely identification and management.
Implementing artificial intelligence in continuous monitoring systems for high-risk patients is recommended. The findings help nurses anticipate potential delays in rapid response team activation, enabling better preparedness.
The study highlights the prevalence of rapid response team delays, timing from admission to rapid response team activation and six prognostic factors influencing delays. It could shape patient care and inform future research. Hospital administrators should review staffing, especially during night shifts, to minimise delays. Further qualitative research is needed to explore why nurses may delay rapid response team activation.
The STROBE checklist was adhered to when reporting this study.
‘No patient or public contribution’.
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