Introduction:
Reducing extubation failure is vital to the early recovery of patients with mechanical ventilation (MV). We aimed to explore the predictive value of the change of intra-abdominal pressure (IAP) before extubation for the extubation failure of MV patients.

Material and methods:
Patients undergoing MV for more than 24 h were selected. We used a urodynamic monitor to measure IAP 30 min before extubation. The characteristics and prognosis of MV patients were analyzed. A receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of IAP for extubation failure.

Results:
A total of 173 MV patients were included. The risks of extubation failure increased with the decrease of IAP. The risk of extubation failure in the IAP ≤ 21 mm Hg group was 5.7 times that of the IAP ≥ 38 mm Hg group (OR = 5.7, 95% CI: 1.5–22.0), the risk of extubation failure in the IAP 22–37 mm Hg group was 3.8 times that of the IAP ≥ 38 mm Hg group (OR = 3.8, 95% CI: 1.0–15.3). The area under the curve (AUC) predicted by IAP for extubation failure was 0.721, the cutoff value was 31 mm Hg with 82.8% sensitivity and 48.6% specificity. There were no significant differences in the duration of MV, length of ICU stay, and death in ICU of the three groups of patients (all p > 0.05).

Conclusions:
The IAP has good reference value for predicting extubation failure, which is negatively correlated with the risk of extubation failure in patients with MV. For MV patients with IAP ≤ 31 mm Hg, they may have higher risk of extubation failure; early alert and interventions are highlighted for those patients.