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COPD Mechanical ventilation (MV) is one of the most common therapeutic modalities provided in the intensive care unit (ICU) [1–3]. Among mechanically ventilated patients, those with chronic obstructive pulmonary disease (COPD) are certainly the most difficult to wean and to extubate [4] owing to more than 50% of the time the patient is receiving MV is spent in the process of weaning [5]. COPD is a progressive degenerative lung disease [6], a major public health burden [7], highly prevalent worldwide [8] causing major morbidity. COPD was identified as the fourth leading cause of death in the United States and the sixth leading cause of years lived with disability [6]. The prevalence of extubation failure was 24% in COPD patients and they have the highest risk for reintubation. Reintubation is an independent risk factor for nosocomial pneumonia, increased costs, lengths of stay, and mortality in mechanically ventilated patients [9], and those patients with extubation failure are up to 7 times more likely to die in the hospital compared with those who are weaned successfully [4]. Furthermore, accurate weaning time is critically important in the population because of any delay or premature ventilation removal may lead to ventilator acquired pneumonia and other possible side effects [1,2,9–14]. In the past 2 decades, great efforts have been devoted to define the most effective approach to weaning patients from MV in different ICU designs and structures [1]; because weaning critically ill patients from MV is a gradual and challenging process [1,10,11]. In this regard, many different weaning predictors have been proposed [10]. In the McMaster review and guidelines, 66 predictors of weaning were reviewed and analyzed. Only eight, including the rapid shallow breathing index (RSBI) or the f/Vt ratio, presented significant likelihood ratios to predict the weaning outcome [15,16]. Along with the international weaning predictors, some Iranian weaning researchers developed ten weaning predictors (NCT01779297) (Table 1). The weaning predictors were validated in the COPD population as student dissertation and have well to excellent results (Table 2). However, some internal and external validations are needed for more approving in the mentioned population.

New weaning indices in chronic obstructive pulmonary disease population