Post extubation management in head injury patients at high risk of re-intubation in trauma intensive care unit

Introduction: Careful clinical assessment is warranted among patients with acute respiratory failure for extubation which should be decided based on the possible benefits and harm related to timing of extubation.

Objective: To characterize the population at high risk for extubation failure and to assess the manoeuvre being used to avoid the occurrence of reintubation in head injury patients admitted to trauma intensive care unit in Qatar.

Materials & Methods: A retrospective data obtained from the trauma registry database of traumatic brain injury patients who were intubated and admitted to trauma intensive care unit in Qatar from January 2013 to December 2015. In total, 297 head injury patients (91.2% males, 8.8% females) at high-risk of re-intubation were selected. Regression analysis was applied to examine the association between successful extubation and in-hospital complications.

Results: The prevalence of agitation and pneumonia have been reported to be 10.8% and 4.7% respectively in post-extubated patients with head injury. After adjusting for confounders, successful extubation with the use of nasal canula and CPAP was significantly associated with less agitation (p= 0.001), and reduced in-hospital complications such as pneumonia (p= 0.001) and sepsis (p= 0.02).

Conclusions: This study suggests as association between successful extubation, less agitation and reduced in-hospital complications such as pneumonia and sepsis. Particular attention and research endeavours should be put into the extubation management of head injury patients.

Keywords: Extubation, reintubation, brain head injury, TICU

NO