Implications of extubation delay in brain-injured patients meeting standard weaning criteria

We hypothesized that variation in extubating brain injured patients would a ffect the incidence of nosocomial pneumonia, length of stay, and hospital c harges. In a prospective cohort of consecutive, intubated brain-injured pat ients, we evaluated daily: intubation status, spontaneous ventilatory param eters, gas exchange, neurologic status, and specific outcomes listed above. Of 136 patients, 99 (73%) were extubated within 48 h of meeting defined re adiness criteria. The other 37 patients (27%) remained intubated for a medi an 3 d (range, 2 to 19). Patients with delayed extubation developed more pn eumonias (38 versus 21%, p < 0.05) and had longer intensive care unit (medi an, 8.6 versus 3.8 d; p < 0.001) and hospital (median, 19.9 versus 13.2 d; p = 0.009) stays. Practice variation existed after stratifying for differen ces in Glasgow Coma Scale scores (10 versus 7, p < 0.001) at time of meetin g readiness criteria, particularly for comatose patients. There was a simil ar reintubation rate. Median hospital charges were $29,057.00 higher for ex tubation delay patients (p < 0.001). This study does not support delaying e xtubating patients when impaired neurologic status is the only concern prol onging intubation. A randomized trial of extubation at the time brain-injur ed patients fulfill standard weaning criteria is justifiable.