• Helena França Correia Dos Reis, Mansueto Gomes-Neto, Almeida Mônica Lajana Oliveira MLO Hospital Geral do Estado da Bahia, Salvador, BA, Brazil., da Silva Mário Ferreira MF Hospital Geral do Estado da Bahia, Salvador, BA, Brazil., Lorena Barreto Arruda Guedes, Bruno Prata Martinez, and de Seixas Rocha Mário M Programa de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil..
• Universidade Federal da Bahia, Salvador, BA, Brazil. Electronic address: helena.correia@ufba.br.
• J Crit Care. 2017 Dec 1; 42: 218-222.

PurposeTo identify predictors and develop a risk score for the prediction of extubation failure in TBI patients.Materials And MethodsWe prospectively evaluated 311 TBI adults receiving mechanical ventilation for >48h in the intensive care unit. Epidemiological, ventilatory, airway protective, laboratory, and hemodynamic predictors were evaluated. A multiple logistic regression model was developed to predict the extubation failure risk. A score was developed using the arithmetic sum of the points for each independent predictor, whose scores were proportional to the regression coefficient. The accuracy of the model was determined using the C statistic.ResultsExtubation failure occurred in 43 patients (13.8%). Five independent predictors were identified: female sex (4 points) Glasgow Coma Scale motor score≤5 (4 points), moderate-to-large secretion volume (4 points), absent or weak cough (3 points), and mechanical ventilation≥10days (2 points). We calculated the risk score for patients and three risk categories were defined: low (0-3 points), moderate (4-7 points), high (8-17 points). The extubation failure rates in the three groups were 3.5%, 21.2%, and 42.9%, respectively.ConclusionThe score developed to predict extubation failure in TBI patients can identify three risk categories and can be easily applied in the ICU.Copyright © 2017 Elsevier Inc. All rights reserved.

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