Miglė Vitartaitė1 , Neringa Balčiūnienė2, Miglė Jurgelėnaitė1
1 Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania
2 Lithuanian University of Health Sciences Medical Academy Neurosurgery Clinic, Neurosurgery Intensive Care Unit, Kaunas, Lithuania
Background and aim. The extubation of patients with neurocritical diseases (ND) is complicated because there are no certain criteria for when extubation is required and standard Intensive Care Unit (ICU) criteria do not apply to this group. The aim was to analyze the extubation rate and factors associated with successful extubation and reintubation of Neurosurgery ICU (NICU) patients.
Materials and methods: this was a retrospective analysis of 109 intubated patients due to severe ND during 2019.01.01-2019.12.31 in LUHS KC NICU. Inclusion criteria: NICU stay and intubation >48 hours, were discharged to another department. Demographic data, diagnoses, frequency of successful extubations and reintubation causes were analyzed.
Results. A total of 109 patients were analyzed. Reasons for NICU admission: cerebrovascular disease (50), traumatic brain injury (46) and other (13) ND. When comparing groups of extubated (n=30) and non-extubated (n=79) (formed tracheostoma) patients there was a statistical significance in age (p=0,036), mechanical ventilation time (p<0,001), Glasgow coma score (GCS) before extubation (p<0,001). Extubated patients Glasgow outcome scale (GOS) score was higher (p<0,001), more patients had positive outcome (4-5 s.) scores compared to non-extubated patients (p<0,001). 12 patients were reintubated: 7 had tracheostoma formed, 5 were extubated. Reintubation reasons: deteriorating consciousness (5), progressing respiratory failure (4), lack of muscle tone, strength to expectorate (1), sudden cardiac arrest (1), generalized seizure attack (1). There was no difference in outcomes of reintubated and non-reintubated patients (p>0,05).
Conclusions: the success of NICU patients’ extubation is determined by better consciousness, younger age, shorter ventilation time. Most common reintubation reasons: deteriorating consciousness, progressing respiratory failure.
Keywords: reintubation, extubation, neurocritical diseases, neurosurgery, intensive therapy.