Extubation failure in patients with COVID-19: Experience from the emergency department of a teaching hospital in Southwestern Colombia

Background: Extubation failure is a common and clinically significant complication in critically ill patients requiring invasive mechanical ventilation, particularly among those with coronavirus disease 2019 (COVID-19). This study aimed to characterize patients with COVID-19 who experienced extubation failure. Methods: We conducted a retrospective cohort study using the institutional COVID-19 registry (RECOVID). The study included patients aged ≥18 years with confirmed COVID-19 who received invasive mechanical ventilation and were extubated in the intensive care unit (ICU) or Emergency Department. Extubation failure was defined as reintubation within 48 hours. Bivariate analyses were performed to assess the associations between clinical variables and extubation outcomes, followed by multivariable logistic regression to identify independent predictors. Results: Among 492 intubated patients, 10.4% experienced extubation failure. Patients with extubation failure were more likely to be female (57% vs. 38%, p = 0.009) and to have a history of cardiac disease (45% vs. 10%, p < 0.001), malignancy (12% vs. 5%, p = 0.03), or immunosuppression (18% vs. 5%, p = 0.004). Extubation failure was associated with longer durations of mechanical ventilation median 17 days, interquartile range (IQR): 12–29 vs. 8 days, IQR: 6–12; p < 0.001, prolonged ICU stay median 24 days, IQR: 17–35 vs. 13 days, IQR: 9–19; p < 0.001, extended hospital stay median 42 days, IQR: 24–55 vs. 21 days, IQR: 14–30; p < 0.001, and higher in-hospital mortality (20% vs. 10%, p = 0.037). Multivariate analysis identified cardiac disease, prolonged mechanical ventilation, and immunosuppression as independent risk factors for extubation failure. Conclusion: Extubation failure occurred in 10% of ventilated COVID-19 patients and was strongly associated with preexisting cardiac disease, immunosuppression, and prolonged mechanical ventilation, leading to longer ICU and hospital stays and higher mortality. These findings highlight the importance of individualized weaning strategies in critically ill COVID-19 patients.