Response

Regarding Dr Tobin's first point, he correctly notes that we did not reference our statement "Moreover, weaning predictors such as maximal inspiratory pressure, static respiratory system compliance, and rapid/shallow breathing index lack sufficient positive and negative predictive value to make them routinely useful for judging patients' ability to wean."1 We do so now in the work by Meade et al.2 In support of our statement, we also reference a study in which Conti et al3 evaluated nine weaning parameters prospectively. Likelihood ratios for all weaning parameters ranged from 0.61 to 1.87, indicating only small, clinically unimportant changes in the posttest probability of success or failure. The authors applied Bayes' theorem and concluded that all indexes were of little use in discriminating those who could be successfully weaned and those who would fail extubation. Consistent with our guideline, they concluded "…the systematic use of these weaning predictors is thus of little use clinically."

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