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TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Ventilator weaning protocols rely in part on objective indices to best predict extubation failure in the critically ill. In this study, we investigated static lung compliance (LC) as a predictor of extubation failure, in comparison to extubation readiness using rapid shallow breathing index (RSBI). METHODS: A cross-sectional, multi-institutional study of 2,334 mechanically ventilated patients admitted from 12/01/2017-12/01/2019. We included all older than 18 years with a documented spontaneous breathing trial and extubation trial. Static lung compliance and RSBI were calculated prior to extubation trial. The primary outcome was extubation failure - defined as need for reintubation within 24 hours from time of extubation. RESULTS: Of the 2,334 patients, 55.6% were males with a mean age of 66-years. The population consisted mostly of Caucasians (74%) and African Americans (20%). 183 of 2,334 (7.84%) patients required reintubation within 24 hours. There was a negative correlation between RSBI and lung compliance at time of extubation trial. The logLC of patients requiring reintubation was significantly lower than those who remained extubated with a mean of 3.58 ± 0.43 vs. 3.69 ± 0.49 (95% CI in difference:0.041 -0.17;p = 0.001). Whereas, log RSBI was not significant for 24-hour reintubation (p = 0.521). Patients were then dichotomized to a compliance of less or greater than 50 and RSBI of less or greater than 104. LC < 50 remained a significant predictor for extubation failure (OR 1.54;95% CI: 1.07-2.22;p = 0.019) whereas, RSBI >104 was not associated with extubation failure (OR 1.53;98% CI:0.20 -11.57;p = 0.674). On multivariate logistic regression after adjusting for age, mode of ventilation, ventilator days, and P/F ratio, LC remained the strongest predictor for 24-hr reintubation (OR 1.56;95% CI: 1.14-2.13). CONCLUSIONS: Static lung compliance measured at the day of extubation is a promising physiological discriminant to evaluate extubation readiness. We recommend further validation studies in prospective cohorts. CLINICAL IMPLICATIONS: Static lung compliance may potentially be used as a discriminant to risk stratify patients with acute respiratory failure for extubation success. DISCLOSURES: No relevant relationships by Lauren Abplanalp, source=Web Response No relevant relationships by Girish Balachandran Nair, source=Admin input No relevant relationships by Enrique Calvo Ayala, source=Web Response No relevant relationships by Limin Yu, source=Web Response