Predictors of Successful Extubation in Neurocritical Care Patients

Abstract

Introduction: Delayed extubation in neurocritical care patients is associated with an increased length of stay in the intensive care unit (ICU), a greater incidence of ventilator-associated pneumonia (VAP), and a poor outcome. There is no evidence available to support use of certain variables over others as predictors of successful extubation in these patients.

Objective: This study aimed to identify predictors of successful extubation.

Material and methods: This was a prospective observational study. The following variables were recorded: neurocritical diagnosis, age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, duration of stay in the ICU, duration of mechanical ventilation, Airway Care Score (ACS), airway occlusion pressure/maximum inspiratory pressure (P 0.1/PIMAx), and the motor score component of the Glasgow Coma Scale (GCS) score. Weaning was defined as successful extubation and absence of ventilatory support for >7 days.

Results: In this prospective cohort of consecutive neurocritical care patients treated over a period of 30 months, we evaluated the following parameters daily: neurological status, intubation status, ventilator parameters, and gas exchange. Of 82 patients, 48 were excluded from the analysis and the remaining 34 patients were included in the analysis. A total of 26 participants (73.5%) achieved successful extubation. Their average age was 39.72 ± 16.43 years. None of the variables that were compared in relation to success or failure of extubation showed statistical significance, except for age (Z = -2.014, P < 0.044 with a Wide confidence interval; Spearman's ρ: r = 0.351, P < 0.042).

Conclusion: In this study, the only predictive factor for successful extubation in neurocritical care patients was an age of <42.5 years.

Keywords: Brain injury; Extubation; Mechanical ventilation; Ventilator weaning.