Extubation failure rates and outcomes in a neurocritical care unit

SESSION TITLE: Mechanical Ventilation: Beyond the basics SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2023 08:30 am - 09:30 am PURPOSE: Extubation failure (EF) has been associated with an increase in-hospital mortality and increased intensive care unit length of stay (ICU-LOS). EF in the Medical Intensive Care Unit (ICU) ranges between 13 to 23%. Studies examining the impact of EF in neurocritical care units (NCCU) are lacking. We conducted a single center prospectively collected cohort study that was retrospectively analyzed to investigate the consequences of EF in a NCCU. EF was defined as re-intubation within 72 hours of extubation. METHODS: Patients admitted to Baylor St. Luke’s Medical Center NCCU from July 2017 to July 2018 were screened. Patients requiring intubation and mechanical ventilation during their hospital stay were included in the study. Baseline demographics, co-morbid conditions, in-hospital mortality (yes/no), tracheostomy (yes/no), ICU-LOS and discharge disposition (favorable/non-favorable) were collected. Discharge to home and in-patient rehabilitation were considered as favorable, while death, hospice and skilled nursing facility were considered unfavorable outcomes. Analysis of variances (ANOVA) and chi-squared tests were used to evaluate the impact of EF. All statistical analyses were performed with R Statistical software (R Foundation, Auckland, New Zealand, 2003). RESULTS: A total of 175 patients were evaluated. EF failure rate was 9% (15/175). Re-intubated patients had higher length of ICU stay (µreint = 23.8 days versus µnoreint = 13.2 days, p-value =0.0001), higher length of hospital stay (µreint = 17.7 days versus µnoreint = 7.74 days, p-value <0.0001) and increased tracheostomy rates (46.7% vs 15%, p-value = 0.0002). There was no difference in in-hospital mortality (13% versus 17%, p-value= 0.8143) and favorable discharge outcomes (33% vs 56%, p-value=0.0978). CONCLUSIONS: Our study showed that extubation failure in a NCCU is associated with a longer length of ICU stay, longer length of hospital stay, and higher tracheostomy rates. Despite these negative consequences, there was no significant difference in in-hospital mortality and favorable discharge outcomes between re-intubated and non-re-intubated patients. Even though there was a general trend towards improved functional outcomes without extubation failure, our sample size may have been too small to show a statistical significance. Our study also showed a slightly lower EF risk in NCCU patients than MICU patients. Generally, NCCU patients are intubated due to imminent respiratory failure and a low Glasgow coma scale score, rather than acute lung pathology. Additionally, prompt neurocritical interventions like mechanical thrombectomy, intravenous thrombolytics, and antiepileptic drugs, notably improve mentation, prevent complications like aspiration pneumonia, and thus, lessen the likelihood of developing EF. Further studies are needed to explore potential interventions that could reduce the rate of extubation failure and its associated consequences in the neurocritical care population. CLINICAL IMPLICATIONS: •NCCU patients overall have lower risk of EF compared to MICU patients.•Re-intubation leads to higher hospital LOS, ICU LOS and tracheostomy rates, without any difference in in-hospital mortality•Our study showed a trend of reintubated NCCU patients to have poorer discharge outcomes, although our results did not show statistical significance.•A larger prospective multi-center study is necessary to explore the leading causes of EF and potential preventative interventions in the NCCU DISCLOSURES: No relevant relationships by Ali Ahmad No relevant relationships by Eric Bershad No relevant relationships by Bilal Butt No relevant relationships by Rahul Damani No relevant relationships by Mohammad Hirzallah No relevant relationships by Syed Omar Kazmi No relevant relationships by Lintu Ramachandran No disclosure on file for Chethan Rao No relevant relationships by Ellen Sylvie Sanchez Mas No relevant relationships by Khwaja Siddiqui No disclosure on file for Emery Steele