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Meta-Analysis
. 2023 Mar 1;51(3):401-412.
doi: 10.1097/CCM.0000000000005769. Epub 2022 Dec 30.

Prognostic Factors Associated With Extubation Failure in Acutely Brain-Injured Patients: A Systematic Review and Meta-Analysis

Shaurya Taran  1   2 , Natalia Angeloni  3 , Ruxandra Pinto  3 , Shawn Lee  4 , Victoria A McCredie  1   2 , Marcus J Schultz  5 , Chiara Robba  6 , Fabio S Taccone  7 , Neill K J Adhikari  1   3
Affiliations
Meta-Analysis

Prognostic Factors Associated With Extubation Failure in Acutely Brain-Injured Patients: A Systematic Review and Meta-Analysis

Shaurya Taran et al. Crit Care Med. .

Abstract

Objective: Extubation failure in brain-injured patients is associated with increased morbidity. Our objective was to systematically review prognostic factors associated with extubation failure in acutely brain-injured adult patients receiving invasive ventilation in an ICU.

Data sources: MEDLINE, Embase, and Cochrane Central were searched from inception to January 31, 2022.

Study selection: Two reviewers independently screened citations and selected English-language cohort studies and randomized trials examining the association of prognostic factors with extubation failure. Studies were considered if they included greater than or equal to 80% adult patients with acute brain injury admitted to the ICU and mechanically ventilated for greater than or equal to 24 hours.

Data extraction: Two reviewers extracted data on population, prognostic factors, extubation outcomes, and risk of bias (using the quality in prognostic factors tool).

Data synthesis: In the primary analysis, adjusted odds ratios (aOR) for each prognostic factor were pooled using random-effects models. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The search identified 7,626 citations, of which 21 studies met selection criteria. Moderate-certainty evidence suggested increased risk of extubation failure with older age (aOR, 3.0 for upper vs lower tertile; 95% CI, 1.78-5.07) and longer duration of mechanical ventilation (aOR, 3.47 for upper vs lower tertile; 95% CI, 1.68-7.19). Presence of cough (aOR, 0.40; 95% CI, 0.28-0.57) and intact swallow (aOR, 0.34; 95% CI, 0.21-0.54) probably decreased risk of extubation failure (moderate certainty). Associations of other factors with extubation failure were informed by low or very low certainty evidence.

Conclusions: Patient age, duration of mechanical ventilation, and airway reflexes were associated with extubation failure in brain-injured patients with moderate certainty. Future studies are needed to determine the optimal application of these variables in clinical practice.

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Conflict of interest statement

Dr. Robba reports being a lecturer for Masimo. Dr. Schultz attended a workshop organized by Hamilton in 2018. Lodging expenses were covered for the invited experts and speakers received a speaker’s fee of CHF 800. Dr. Schultz is also the Team Leader of Medical Affairs at Hamilton Medical AG, Switzerland, since 2022. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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References

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