RESEARCH ARTICLE Predictors of Extubation Failure in Neurocritical Patients Identified by a Systematic Review and Meta-Analysis

. These authors contributed equally to this work. Background: Prediction of extubation failure, particularly in neurocritical patients, is unique and controversial. We conducted a systematic review and meta-analysis to identify the risk factors for extubation failure in these patients. Methods: A literature search of databases (MEDLINE, EMBASE, the Cochrane Library, and Web of Science) was performed up to August of 2013 to identify trials that evaluated extubation failure predictors. Included trials were either prospective or retrospective cohort studies. Results: Nine studies involving 928 participants were included. The systematic review and meta-analysis revealed that the following were predictive for extubation failure: pneumonia, atelectasis, mechanical ventilation of.24 h, a low Glasgow Coma Scale score (7–9T) (OR54.96, 95%CI51.61–15.26, P50.005), the inability to follow commands (OR52.07, 95%CI51.15–3.71, P50.02), especially the command to close the eyes, thick secretion, and no intact gag reflex. Meanwhile, the followin