# Handgrip strength association with weaning outcome in mechanically ventilated ICU patients: a systematic review and meta-analysis

## TL;DR

This study finds that handgrip strength may not reliably predict successful weaning from ventilators in ICU patients, despite being a simple measure of muscle strength.

## Contribution

The study is the first to systematically review and meta-analyze the relationship between handgrip strength and weaning outcomes in ICU patients.

## Key findings

- Handgrip strength was not significantly different between extubation success and failure.
- Lower handgrip strength was significantly associated with spontaneous breathing trial failure and non-simple weaning.
- The predictive accuracy of handgrip strength for weaning outcomes was moderate, with high negative predictive values.

## 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.

The online version contains supplementary material available at 10.1186/s13054-025-05729-5.