Critical Care volume 29,
Article number: 478 (2025) Published: 07 November 2025
Abstract
Weaning from
mechanical ventilation is a critical process in the intensive care unit (ICU),
and extubation failure remains associated with poor outcomes. ICU-acquired
weakness has been identified as a risk factor for delayed weaning. Maximal
handgrip strength (HGS) is a simple bedside measure proposed as a surrogate
marker of global muscle strength. This systematic review and meta-analysis
aimed to assess the association between HGS and weaning outcomes in ICU
patients. A systematic search of MEDLINE, EMBASE, CINAHL, and Cochrane Library
was conducted up to December 2024. We included prospective cohort studies
assessing maximal HGS prior to extubation in mechanically ventilated adults,
and its association with extubation failure, spontaneous breathing trial (SBT)
failure, or weaning classification (simple, difficult, or prolonged).
Meta-analyses pooled mean differences in HGS between outcome groups, and
diagnostic accuracy was evaluated using a hierarchical summary ROC model. Risk
of bias was assessed using the QUIPS tool. Seven studies were included in the
review (n = 707 patients), and six in the meta-analysis.
No significant difference in HGS was found between extubation failure and
success (mean difference: − 3.62 kg; 95% CI: − 7.92 to 0.62). However, significantly lower
HGS was associated with SBT failure (–3.00 kg; 95% CI: − 4.64 to − 1.36) and non-simple
weaning (–3.94 kg; 95% CI: − 5.31
to − 2.58). Pooled sensitivity and specificity of
HGS were 72% and 60% respectively, in predicting either extubation failure or
non-simple weaning. Negative predictive values ranged from 90% to 95%, for 10%
and 20% pre-test probability. Maximal HGS does not appear to significantly
differentiate extubation success from failure Given the limited number of
studies and their heterogeneity, further high-quality research is needed to
clarify its prognostic value across different patient subgroups and timeframes.
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