title: Association of Extubation Failure and Functional Outcomes in Patients with Acute Neurologic Illness.
abstract: BACKGROUND
  An association between extubation failure and neurologic and functional outcomes in patients with primary neurologic illness has not been investigated rigorously. We plan to conduct a retrospective chart review to study this association.
  
  
  METHODS
  A total of 949 unique patients intubated and ventilated for at least 48 h in Neuro ICU (NICU) were obtained. Extubation failure was defined as need for reintubation within 48 h of initial extubation. Independent and dependent association between extubation failure and clinical parameters was assessed.
  
  
  RESULTS
  The patients had a median age [interquartile range (IQR)] of 58.5 (23.0) years. 60.5% were male and 81.9% were Caucasian. Extubation failure occurred in 108 (12.8%) patients. There was no difference in age, APACHE 3 score, FOUR score, or GCS score of patients at ICU admission between those who experienced extubation failure and those who did not. Extubation failure was associated with longer NICU and hospital LOS [median (IQR); 13.7 (11.3) vs. 9.1(8.2) days, P < 0.01 and 24.5 (20.0) vs. 16.8 (16.7) days, P < 0.01]. Patients with extubation failure had worse functional outcomes at 6 months as measured by the modified Rankin score [MRS; median (IQR), 5.0 (2.0) vs. 4.0 (3.0), P < 0.01]. After adjusting for confounders, extubation failure was associated with longer hospital and ICU LOS and worse functional outcomes.
  
  
  CONCLUSIONS
  In patients with acute neurological illness, extubation failure is associated with longer ICU and hospital stays but does not impact hospital mortality. Patients with extubation failure may experience a worsening of their functional status over time.
authors.affiliation: Multidisciplinary Epidemiological and Translational Research in Critical Care Medicine (METRIC), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. rishi.muhammad@mayo.edu.
authors.forename: Muhammad Adeel
authors.initials: MA
authors.lastname: Rishi
authors.affiliation: Multidisciplinary Epidemiological and Translational Research in Critical Care Medicine (METRIC), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.affiliation: Multidisciplinary Epidemiological and Translational Research in Critical Care Medicine (METRIC), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilson
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Schenck
authors.affiliation: Division of Critical Care Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Hocker
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial; D019233:Retreatment; D012189:Retrospective Studies
keywords: Extubation failure; Mechanical ventilation; Neurological ICU; Reintubation; Respiratory failure