Richard Choi
Patients intubated for primarily neurological reasons represent a unique critically-ill population. Extubation failure rates in Primary Brain Injury (PBI) patients are 18%-38% compared to 13%-18% in the general critical care population. These populations have never been directly compared. We hypothesized that intubated PBI patients would have higher rates of extubation failure compared to non-PBI patients.A retrospective cohort of intubated patients with and without PBI admitted between October 1, 2008 and September 30, 2010 who had a planned non-terminal trial of extubation in either the Medical Intensive Care Unit and Neurocritical Care Unit in a tertiary-care university hospital. Of the 1684 patient charts reviewed, 349 were included; 107 patients had PBI, and 242 did not have PBI. Combined extubation failure rates before 48 hours, 72 hours and 1 week were 13.7%, 17.5%, and 22.9%, respectively. Comparing PBI patients with non-PBI patients, extubation failure rates at the same time points were 19% vs. 12% (p=0.091), 24% vs. 14% (p=0.032) and 29% vs. 20% (p=0.097). PBI patients had a significant increased relative risk of failing before 72 hours (OR 1.90 (95% CI 1.07-3.35), p=0.027). PBI patients had fewer ventilator days prior to their extubation attempt than nonPBI patients 4 days (3 days-6 days) vs. 5 days (3 days-8 days), p=0.007). There was no difference in rates of extubation failure in PBI patients admitted to the NeuroICU (24.4%) vs. the MICU (24.1%). PBI patients were more likely to develop Ventilator-Associated Pneumonia (VAP) [OR 5.58 (1.41-22.00), p=0.014]. Failing extubation at 72 hours did not put patients at increased odds for VAP. PBI patients who failed at 72 hours did not have a significant increase in ventilator days, intensive care unit days or mortality; however, none of these patients were discharged to home