Call to research in ventilator weaning and extubation in neurocritical care

Patients with neurological injuries requiring admission to
intensive care units (ICUs) may require invasive mechanical ventilation to support airway maintenance and breathing due to respiratory compromise from central or peripheral neurological pathology (Bosel, 2017). In this patient population, there is limited evidence to support decisions related to ventilator weaning and extubation readiness. This can cause delays in the decision to extubate. Delayed extubation has significant clinical implications such as increased morbidity from sedatives, development of nosocomial infections and increased length of stay (Boles et al., 2007; Bosel, 2017; Mullaguri et al., 2018). Additionally,
extubation failure rates range between 20% and 40% in neurocritical care patients (Bosel, 2017), with failure associated with the development of ventilator associated pneumonia, increased mortality and poor functional status (McCredie et al., 2017; Reis et al., 2013; Rishi et al., 2016).
Despite the significant risks associated with delayed extubation and extubation failure, there is a lack of studies of high methodological quality focussing on predictors of successful extubation in neurocritical care patients. This results in a weak evidence base (Bosel, 2017; Jibaja et al., 2018). Whilst evidence supports predictors of extubation readiness in general ICU populations such as the Rapid Shallow Breathing Index, most conventional parameters do not predict extubation failure in neurocritical care patients (Ko et al., 2009). This creates a significant challenge for clinicians making decisions about extubation