Development of a prediction score for evaluation of extubation readiness in neurosurgical patients with mechanical ventilation.

Abstract

There is no widely accepted consensus on the weaning and extubating protocols for neurosurgical patients, leading to heterogeneity in clinical practices and high rates of delayed extubation and extubation failure-related health complications. In this single-center prospective observational diagnostic study, mechanically ventilated neurosurgical patients with extubation attempts were consecutively enrolled for one year. We surveyed responsive physicians for the reasons for delayed extubation and developed the STAGE (Swallowing, Tongue protrusion, Airway protection reflected by spontaneous and suctioning cough, and Glasgow coma scale Evaluation) score to predict the extubation success for neurosurgical patients already meeting other general extubation criteria. A total of 3171 patients were screened consecutively and 226 patients were enrolled in this study. Rates of delayed extubation and extubation failure were 25% (57/226) and 19% (43/226), respectively. The most common reasons for the extubation delay were weak airway protecting function and poor consciousness. The area under the receiver operating characteristics curve of the total STAGE score associated with extubation success was 0.72 (95% CI: 0.64 to 0.79). Guided by the highest Youden index, the cutoff point for the STAGE score was set at 6 with 59% (95% CI: 51% to 66%) sensitivity, 74% (95% CI: 59% to 86%) specificity, 90% (95% CI: 84% to 95%) positive predictive value, and 30% (95% CI: 21% to 39%) negative predictive value. At STAGE scores ≥ 9, the model exhibited a 100% (95% CI: 90% to 100%) specificity and 100% (95% CI: 72% to 100%) positive predictive value for predicting extubation success. After surveying the reasons for delayed extubation, we developed the STAGE scoring system to better predict the extubation success rate. We believe that this scoring system has promising potential in predicting extubation readiness and may help clinicians avoid delayed extubation and failed extubation-related health complications in neurosurgical patients.