To identify the independent risk factors for extubation in neurological critically ill patients who had been intubated for more than 48 hours and passed the weaning test, and to establish an extubation risk prediction model.

The data of 83 neurological critically ill patients who received standardized monitoring and treatment in the neurological intensive care unit of the First Affiliated Hospital of Anhui Medical University from April 2020 to August 2023 were collected. According to whether they needed re-intubation or tracheotomy within 96 hours after extubation, the 83 patients were divided into a successful extubation group (61 cases) and a failed extubation group (22 cases). The general data, neurological function, airway protection ability, and physiological and biochemical indicators of the two groups were compared, and finally a prediction model was established by multivariate regression analysis. The receiver operating characteristic (ROC) curve was further drawn to test the predictive value, sensitivity, and specificity of research results, and the area under the curve (AUC) of each score was compared by the Z test.

Among the 83 patients, 61 patients (73.5%) were successfully extubated, and 22 patients (26.5%) were reintubated due to respiratory dysfunction within 96 hours after extubation. There were significant differences in the Glasgow coma scale-motor (GCS-M) score, muscle strength grade, consciousness level before extubation, choking reaction, swallowing function, oxygen inhalation method after extubation, body temperature before extubation, blood sodium concentration, Godet's score, VISAGE score, and respiratory insufficiency scale-intubated (RIS-i) score between the two groups (all P < 0.05). The GCS-M score, consciousness level before extubation, choking reaction, swallowing function, and body temperature before extubation were included in multivariate logistic regression analysis. The results showed that the GCS-M score before extubation < 4 [odds ratio (OR) = 8.835, 95% confidence interval (CI) (1.638, 47.659), P = 0.011], choking reaction > grade Ⅱ [OR = 10.281, 95%CI (2.366, 44.129), P = 0.002], and body temperature ≥ 37 ℃ [OR = 4.506, 95%CI (1.024, 19.833), P = 0.046] were risk factors for extubation failure in neurological critically ill patients. Each independent risk factor was further scored according to the OR value, and a risk prediction scale for failure of extubation in critically ill patients with neurological diseases was established, with a total score of 5. ROC analysis showed that the sensitivity of the scale score > 1 in predicting failure of extubation (high risk of failure) was 77.3%, the specificity was 85.2%, and the AUC was 0.850 [95%CI (0.775, 0.919), P < 0.001]. The Z test showed that the predictive value of the current scale was higher than that of the Godet's score (Z = 2.050, P = 0.040) and VISAGE score (Z = 1.990, P = 0.047).

This clinical prediction score can provide guidance for extubation in critically ill patients with neurological diseases after weaning.