Prognostic Factors Associated with Extubation Failure in Acutely Brain-Injured Patients: A Systematic Review and Meta-Analysis∗
Issued Date
2023-03-01
Resource Type
ISSN
00903493
eISSN
15300293
Scopus ID
2-s2.0-85148679048
Pubmed ID
36583622
Journal Title
Critical Care Medicine
Volume
51
Issue
3
Start Page
401
End Page
412
Rights Holder(s)
SCOPUS
Bibliographic Citation
Critical Care Medicine Vol.51 No.3 (2023) , 401-412
Suggested Citation
Taran S., Angeloni N., Pinto R., Lee S., McCredie V.A., Schultz M.J., Robba C., Taccone F.S., Adhikari N.K.J. Prognostic Factors Associated with Extubation Failure in Acutely Brain-Injured Patients: A Systematic Review and Meta-Analysis∗. Critical Care Medicine Vol.51 No.3 (2023) , 401-412. 412. doi:10.1097/CCM.0000000000005769 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82670
Title
Prognostic Factors Associated with Extubation Failure in Acutely Brain-Injured Patients: A Systematic Review and Meta-Analysis∗
Author's Affiliation
Faculty of Tropical Medicine, Mahidol University
Institute of Health Policy, Management and Evaluation
Hamilton Medical AG
Hôpital Erasme
Sunnybrook Health Sciences Centre
Università degli Studi di Genova
University of Toronto Faculty of Medicine
University Health Network University of Toronto
Nuffield Department of Medicine
Amsterdam UMC - University of Amsterdam
Institute of Health Policy, Management and Evaluation
Hamilton Medical AG
Hôpital Erasme
Sunnybrook Health Sciences Centre
Università degli Studi di Genova
University of Toronto Faculty of Medicine
University Health Network University of Toronto
Nuffield Department of Medicine
Amsterdam UMC - University of Amsterdam
Other Contributor(s)
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.