Association of age with extubation failure in neurocritical intensive care unit patients––Insight from an international prospective study named ENIO

Objective: To assess the association of age with extubation failure in neurocritical care patients. Design: Posthoc analysis of the ‘Extubation strategies in Neuro–Intensive care unit patients and associations with Outcomes (ENIO) study’, an international prospective observational study. Setting: ENIO was conducted in 73 centers in 18 countries from 2018 to 2020. Patients: Neurocritical care patients with a Glasgow Coma Scale score ≤ 12 and receiving ventilation for at least 24 h were included. We categorized patients into four age groups based on age quartiles. Main results: This analysis included 1095 patients with a median age of 53 [35 to 65] years. Younger patients were more likely to be admitted with traumatic brain injury, whereas older patients more often had cerebral hemorrhage, ischemic stroke, central nervous infection, or brain malignancies. Extubation failure occurred in 209 (19 %) patients. In the unadjusted analysis, older patients had a higher risk of extubation failure (odds ratio (OR), 1.012 [95 %–confidence interval (CI) 1.004 to 1.021]; P = 0.006). However, after adjusting for confounding factors, the effect of age on extubation failure was no longer significant (OR, 1.008 [0.997 to 1.019]; P = 0.172). Conclusions: In this international cohort of intubated and ventilated neurocritical care patients, after adjusting for baseline covariates and for previously identified risk factors for extubation failure, age was not associated with extubation failure. Age may not be a factor to consider in extubation decisions for brain–injured patients. Registration: ENIO is registered at clinicaltrials.gov (study identifier NCT 03400904).