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March 26, 2026

486: Associations Between Neuroimaging Findings and Extubation Failure in Traumatic Brain Injury

Key Points

The aim is to explore the relationship between neuroimaging findings and extubation failure in patients with severe traumatic brain injury.
Retrospective analysis of patients with moderate to severe TBI with GCS ≤12
Included patients on invasive mechanical ventilation for ≥24 hours
Reviewed neuroimaging findings from head CT scans on admission and prior to extubation
Used multivariable logistical regressions to assess associations between extubation failure and neuroimaging findings
32 out of 181 patients (17.68%) experienced extubation failure
Associations found between pre-extubation neuroimaging findings and extubation failure, including higher Marshall, Rotterdam, and Helsinki scores
Edema score ≥3 and cisternal compression on CT were also associated with higher extubation failure risk
No associations were found for neuroimaging findings on admission CT

Abstract

Introduction: The ability to predict successful extubation in patients with acute brain injury remains inadequate, reflected by high extubation failure rates in this population and imperfect predictive models. We examined associations between neuroimaging findings and extubation failure in patients with moderate to severe traumatic brain injury (TBI). Methods: In this single center retrospective study (2021-2025), we included patients with TBI and Glasgow Coma Scale (GCS) ≤12 who received invasive mechanical ventilation (IMV) for ≥24 hours and underwent an extubation trial. Patients with cervical spinal cord injury and major chest trauma were excluded. The primary outcome was extubation failure within 5 days of extubation. Head computed tomography (CT) scans on admission and prior to extubation were reviewed. Using multivariable logistical regressions adjusting for age, GCS, and prior cardiopulmonary disease, we assessed associations between extubation failure and multiple pre-defined neuroimaging findings, including validated TBI scoring systems and structural lesions of neuroanatomical structures involved in airway protection. Results: Of 181 patients included (mean age 45 years, 26% female, 92% admission GCS 3-8, 42% underwent neurosurgical intervention, median IMV 2.2 days IQR 1.5-4.7), 32 (17.68%) experienced extubation failure. Marshall score 3/4/6 (OR 2.9, 95% CI 1.1-7.1), Rotterdam score ≥3 (OR 2.6, 95% CI 1.1-7.1), Helsinki score ≥6 (OR 3.5, 95% CI 1.4-8.4), edema score ≥3 (OR 4.0, 95% CI 1.7-10) and presence of cisternal compression (OR 3.1, 95% CI 1.4-7.4) on pre-extubation CT (obtained within a median of 1.5 days (IQR 0.9-3) prior to extubation) were associated with extubation failure, however, no associations were found for the same findings on the admission CT. Conclusions: Neuroimaging findings on pre-extubation CT but not admission CT were associated with extubation failure. The predictive value of neuroimaging findings within extubation failure warrants further evaluation.

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Cite This Study

Abu-Alya et al. (Sun,) studied this question.

synapsesocial.com/papers/69c4cd8dfdc3bde44891a10e https://doi.org/https://doi.org/10.1097/01.ccm.0001183940.97462.b3

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