Extubation timing and risk of extubation failure in aneurysmal subarachnoid hemorrhage patients

The extubation time is critical during the intensive care unit stay in aneurysmal subarachnoid hemorrhage (aSAH) patients. The current conventional parameters for predicting extubation failure (EF) and extubation time may not be suitable for this population. Here, we aimed to identify factors associated with EF in aSAH patients.

From a single-center observational study on aSAH patients with computed tomography angiography from 2019 to 2021, patients who received microsurgery were enrolled and divided into two groups according to whether EF occurred. Multivariable logistic regression was conducted to evaluate disease severity, medical history, and extubation time differences between patients with and without EF.

Of 335 patients included, EF occurred with a rate of 0.14. Delayed cerebral ischemia (67.4% vs. 13.5%) and acute hydrocephalus (6.5% vs. 1.4%) were frequently observed in patients with EF. Also, patients who develop EF presented higher disability (65.9% vs. 17.4%) and mortality (10.9% vs. 0.7%) rates. Multivariable analysis demonstrated that age (OR 1.038; 95% CI 1.004-1.073; P = 0.028), onset to admission time (OR 0.731; 95% CI 0.566-0.943; p = 0.016), WFNS grade > 3 (OR 4.309; 95% CI 1.639-11.330; p = 0.003), and extubation time < 24 h (OR 0.097; 95% CI 0.024-0.396; p = 0.001) were significantly associated with EF occurrence.

These data provide further evidence that older aSAH patients with onset to admission time < 2 days and WFNS grade > 3 have a high risk of developing EF, which is amplified by the ultra-early extubation. Moreover, in patients with two or more risk factors, a prolonged intubation recommendation requires consideration to avoid the EF.