Extubation in the neurocritically ill patient with acute brain injuries: a narrative literature review

Abstract

Introduction: Ventilator weaning and extubation in patients with acute brain injuries pose a challenge for healthcare professionals due to the lack of clear consensus on extubation criteria. Objective: To summarize the available evidence on extubation of patients with acute brain injuries and analyze potential alternatives to the classical extubation criteria. Methods: A literature search was conducted in the Spanish and English languages, covering the last 20 years, across different databases. Systematic reviews with or without meta-analysis, guidelines and recommendations from scientific societies, clinical trials, and observational studies that met the inclusion criteria were included. Results: A total of 262 relevant articles were collected, of which, through analysis and comparison of the evidence, 48 articles were selected as most relevant to fulfill the stated objective. Conclusions: The available evidence is weak in providing a recommendation on extubation criteria for neurocritical patients. Early extubation could be considered in patients with a minimal level of consciousness while maintaining protective airway reflexes, without an increase in reintubation rate or mortality.

Keywords

• airway extubation
• brain injuries
• traumatic
• critical care
• neurologic manifestations
• weaning