Risk Factors for Extubation Failure and Prolonged Intubation in Patients With Acute Brain Injury Following Surgery: A Retrospective Study

ABSTRACT Background Acute brain injury (ABI) is a severe, life‐threatening condition with high mortality and morbidity rates. Surgical intervention is often necessary for patients with intracranial hematomas or refractory increased intracranial pressure, necessitating intubation and mechanical ventilation. These patients may experience both extubation failure and prolonged intubation during treatment. This study analyzed the risk factors associated with extubation failure and prolonged intubation in patients with ABIs who underwent surgery. Methods In this retrospective cohort study, 641 adult patients with ABIs, including spontaneous intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, and traumatic brain injury, who required mechanical ventilation for > 48 h and survived for > 14 days after surgery, were included. Clinical data, including demographics, clinical characteristics, Glasgow coma scale (GCS) scores, and laboratory test results, were analyzed at admission and before extubation. Results The mean age of recruited patients was 61.12 ± 16.60 years. In total, 496 (92.9%) patients were successfully extubated after meeting the criteria for weaning and passing the spontaneous breathing test, and 38 (7.1%) were reintubated. Prolonged intubation (> 14 days) was observed in 217 patients (33.9%). Multivariable regression analysis was conducted to identify independent predictors. GCS at the time of extubation was an independent predictor of reintubation, whereas age and initial GCS were identified as independent predictors of prolonged intubation. Conclusion This study comprehensively characterizes indicators of both extubation failure and prolonged intubation in patients with ABI following surgery. Identifying these risk factors will enable timely intervention and precise prognostic assessment during the early management of patients with ABI.