Extubation based on predictive scales in the management of neurocritical patients: Narrative review and update

Abstract

Introduction: invasive mechanical ventilation (IMV) is essential in neurocritical patients to ensure oxygenation, control ventilation and prevent secondary brain damage, although its prolonged use is associated with complications such as ventilator-associated pneumonia (VAP) and increased mortality. Extubation in this population faces failure rates of up to 40 %, highlighting the need for specific strategies. Method: a narrative review was conducted based on original articles, case series and open access systematic reviews, consulted in SciELO, LILACS, Scopus, PubMed-Medline, Google Scholar and ClinicalKey. DeCS descriptors and Boolean operators were used, excluding letters to the editor and conference proceedings to prioritise quality evidence. Development: extubation in neurocritical patients is compromised by neurological (altered level of consciousness, reflex dysfunction), respiratory (secretions, weak cough) and systemic (prolonged IMV) factors. Scales such as VISAGE, AIRWAY SCORE and ENIO integrate key variables to predict success, although they lack universal validation. Tracheostomy reduces duration of IMV, but not VAPV or mortality, while physiotherapy shows unconfirmed potential. Conclusions: predictive scales offer valuable tools, but their standardisation is limited. Level of consciousness does not consistently predict success, prioritising airway protection. Prospective studies are needed to develop specific protocols and improve outcomes in neurocritical patients.