Predictors of extubation failure in Neuro-critically ill patients in KNH ICUs

Abstract

Background Extubation decisions in brain-injured patients are often challenging to the critical care practitioner. Neuro-critically ill patients often undergo prolonged mechanical ventilation and intubation, are at high risk of extubation failure and have high morbidity and mortality. Extubation failure is an outcome to be avoided since it is associated with worse outcomes in ICU patients. Tools, scores and interventions to reduce extubation failure will be beneficial to the care of this subset of critically ill patients. Objective To determine the incidence and predictors of extubation failure in neuro-critically ill patients in Kenyatta National Hospital (KNH). Methodology A prospective observational cohort study of neuro-critically ill patients admitted in KNH critical care units. Patients included were ≥14 years, had neuro-critical illness and were mechanically ventilated for >24 hours. 105 patients were included into the study and 80 extubation events analyzed. The primary outcome was extubation failure within 72 hours of the index extubation. Results The incidence of extubation failure was 37.5%. Independent predictors of extubation failure included: a diagnosis of traumatic brain injury, pre-extubation FOUR score ≤10 and duration of mechanical ventilation > 10 days. Operative intervention was associated with reduced risk of extubation failure.