Patient factors associated with extubation failure among neurological patients on mechanical ventilation admitted at intensive care unit at Jaramogi Oginga Odinga Teaching and Referral Hospital and Kakamega County Government Teaching and Referral Hospital

Abstract

Extubation for patients in neuro-critical care under mechanical ventilation is one of the most significant and critical medical interventions. The aforesaid patients may require extubation owing to the challenges that they face during weaning and removal of the tube when compared to their counterparts in intensive care. The problem for the nuero-critical-based patients under mechanical ventilation is often due to an upsurge in secretion production, difficulties in speech and swallowing capability, weak airway capacity and stiff breathing control. The risk of extubation failure continues to be a major concern in neurocritical care settings. This complication occurs when patients require the breathing tube to be reinserted within 72 hours after it was intentionally removed, indicating that the initial attempt to discontinue mechanical ventilation was unsuccessful with failed extubation among neurological patients admitted to intensive care units. This study employed a analytical cross-sectional design using quantitative approaches to identify significant patient factors associated with extubation failure. Retrospectively, the study conducted chart review of patient files of critically ill neurological patients admitted to the Intensive Care Unit ICU between March 2024 to March 2025, subjected to invasive mechanical ventilation between 24 hours and 10 days. Data were collected on patient demographics, neurological diagnosis, Glasgow Coma Scale (GCS), duration of mechanical ventilation, respiratory parameters, airway clearance ability, secretion burden, and amongst others. The findings indicate that extubation failure remains a common and serious challenge in neurocritical care settings. The notable contributing factors included excessive airway secretions, difficulty in the resipiratory capability, weak cough reflexes and prolonged ventilator exposure. The patients who experienced extubation failure had higher inclinations to aspiration, longer ICU exposure, and pneumonia and ventilator support challenges. The study thus concludes that standardized extubation readiness evaluation, professional patient selection, multi-disciplinary decision-making plus effective post-extubation assessment are needed to deal with extubation failure among neurological patients. Further, the use of evidence-based and research-oriented extubation practice is vital for patients under mechanical ventilation. This study thus recommends that evidence-based extubation failure should be practiced more effectively in hospitals.