Analysis of factors affecting smooth extubation in delayed extubation patients following intracranial surgery: an...

Delayed extubation is common after intracranial surgery, and is associated with adverse reactions that compromise patient safety and comfort. Identifying factors that influence smooth extubation is therefore critical, but available evidence is limited. This study aims to explore risk factors of extubation adverse outcomes in patients undergoing craniocerebral surgery, with the goal of enhancing extubation safety and patient comfort.

An ambispective cohort study was conducted at a university hospital from May 2022 to September 2023, involving 157 patients with delayed extubation post-intracranial surgery. Clinical data encompassing demographic characteristics, neurological status, respiratory parameters, intraoperative and anesthetic management, and postoperative factors. Smooth extubation was defined as extubation with stable blood pressure, respiratory function, and absence of pain or agitation. Multivariate logistic regression identified independent factors influencing adverse extubation.

Of 157 patients (mean BMI 23.88 ± 3.25 kg/m², 33.1% male), adverse extubation occurred in 80 (51.0%). Univariate analysis showed several significant variables (P < 0.05): age, FOUR_E, FOUR_M, airway patency, Duration from command obedience to extubation, time to extubate, types of surgical procedure, operation duration, intraoperative propofol use, sedation before. Multivariate analysis showed: age [OR = 2.791, 95%CI (1.268, 6.147)], intraoperative propofol use [OR = 0.298, 95%CI (0.012, 0.796)], preoperative airway patency [OR = 2.463, 95%CI (1.159, 5.234)], time to extubate [OR = 7.884, 95%CI (1.337, 46.472)] as independent factors of dverse extubation.