• Shaurya Taran, Natalia Angeloni, Ruxandra Pinto, Shawn Lee, Victoria A McCredie, Marcus J Schultz, Chiara Robba, Fabio S Taccone, and AdhikariNeill K JNKJInterdepartmental Division of Critical Care Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, .
• Interdepartmental Division of Critical Care Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
• Crit. Care Med. 2023 Mar 1; 51 (3): 401412401-412.

ObjectiveExtubation 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 SourcesMEDLINE, Embase, and Cochrane Central were searched from inception to January 31, 2022.Study SelectionTwo 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 ExtractionTwo reviewers extracted data on population, prognostic factors, extubation outcomes, and risk of bias (using the quality in prognostic factors tool).Data SynthesisIn 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.ConclusionsPatient 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.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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