title: Extubation failure influences clinical and functional outcomes in patients with traumatic brain injury.
abstract: OBJECTIVE
  To evaluate the association between extubation failure and outcomes (clinical and functional) in patients with traumatic brain injury (TBI).
  
  
  METHODS
  A prospective cohort study involving 311 consecutive patients with TBI. The patients were divided into two groups according to extubation outcome: extubation success; and extubation failure (defined as reintubation within 48 h after extubation). A multivariate model was developed in order to determine whether extubation failure was an independent predictor of in-hospital mortality.
  
  
  RESULTS
  The mean age was 35.7 ± 13.8 years. Males accounted for 92.3%. The incidence of extubation failure was 13.8%. In-hospital mortality was 4.5% and 20.9% in successfully extubated patients and in those with extubation failure, respectively (p = 0.001). Tracheostomy was more common in the extubation failure group (55.8% vs. 1.9%; p < 0.001). The median length of hospital stay was significantly greater in the extubation failure group than in the extubation success group (44 days vs. 27 days; p = 0.002). Functional status at discharge was worse among the patients in the extubation failure group. The multivariate analysis showed that extubation failure was an independent predictor of in-hospital mortality (OR = 4.96; 95% CI, 1.86-13.22).
  
  
  CONCLUSIONS
  In patients with TBI, extubation failure appears to lengthen hospital stays; to increase the frequency of tracheostomy and of pulmonary complications; to worsen functional outcomes; and to increase mortality.
authors.affiliation: Graduate Program in Medicine and Human Health, Bahia School of Medicine and Public Health, Federal University of Bahia, Salvador, Brazil. lenafran@gmail.com
authors.forename: Helena França Correia dos
authors.initials: HF
authors.lastname: Reis
authors.forename: Mônica Lajana Oliveira
authors.initials: ML
authors.lastname: Almeida
authors.forename: Mário Ferreira da
authors.initials: MF
authors.lastname: Silva
authors.forename: Mário de Seixas
authors.initials: Mde S
authors.lastname: Rocha
mesh_terms: D000328:Adult; D060666:Airway Extubation / Q000401:mortality*; D001930:Brain Injuries / Q000401:mortality*; D001938:Brazil / Q000453:epidemiology; D005260:Female; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D019233:Retreatment / Q000706:statistics & numerical data; D014139:Tracheostomy / Q000706:statistics & numerical data; D015300:Ventilator Weaning / Q000706:statistics & numerical data; D055815:Young Adult