Clinical-Demographic Profile and Outcome of Mechanical Ventilator Liberation in Neurologically Critical Patients of Southeastern Mexico

Abstract

Background: Invasive Mechanical Ventilation (IMV) is essential in most neurologically critical patients. Therefore, it is important to provide conditions that protect the airway and prevent secondary brain damage. However, physiological instability increases the risk of failure in mechanical ventilator liberation. The demographic, clinical, and ventilatory characteristics of the patients influence the outcome of extubation. Aim: To know the clinical-demographic profile and outcome of mechanical ventilator liberation in neurologically critical patients in Southeast Mexico. Methods: Retrospective and descriptive study that included patients (n=50) of both sexes, ≥18 years of age, admitted to the Intensive Care Unit (ICU) of a second-level Public Hospital located in Southeast Mexico with a confirmed diagnosis of brain injury of traumatic or non-traumatic origin between January and July 2024. Patients transferred to other medical units were excluded. Demographic, clinical, and ventilatory data were collected. Descriptive statistics were applied using SPSS version 25. Results: The sample size was 50 clinical records. Demographic data showed a mean age of 47.1 ± 19.0 years and higher proportion of women (60.0%). Patients with non-traumatic brain injury represented 52.0%. The Glasgow Coma Scale (GCS) score upon admission to the ICU was 9.3 ± 3.4. The mean time on mechanical ventilation was 8.80 ± 5.40 days. The mean values ​​at the time of weaning from mechanical ventilation were: Systolic Blood Pressure (SBP) (mmHg) 130.3 ± 12.5; Diastolic Blood Pressure (DBP) (mmHg) 79.7 ± 10.9; Mean Arterial Pressure (MAP) (mmHg) 96.5 ± 9.5; Heart Rate (HR) (beats/minute) 84.0 ± 14.0; Respiratory Rate (RR) (breaths/minute) 27.2 ± 7.0; Partial Pressure of Oxygen in Arterial Blood (PaO2) (mmHg) 77.6 ± 7.9; Kirby Index (PaO2/FiO2) 274.2 ± 70.1; Positive End-Expiratory Pressure (PEEP) (cm H2O) 7.4 ± 2.2; Tobin Index (RR/Vt) (breaths/minute/liter) 71.6 ± 26.2. The Airway Care Score (ACS) was 5.7 ± 2.7; and the Full Outline of Unresponsiveness [FOUR] Coma Scale 10.2 ± 2.7. Positive total fluid balance was present in 42.0%. The outcome of mechanical ventilator weaning was simple in 50.0%; prolonged in 32.0%; and difficult in 18.0%. Conclusion: The results showed that demographic, clinical, and ventilatory characteristics can influence the outcome of mechanical ventilator liberation in neurologically critical patients of southeastern Mexico. Understanding these factors is crucial for the timely identification of adverse conditions that can lead to weaning from mechanical ventilation failure, morbidity, mortality, and increased hospital costs.