MULTIDIMENSIONAL PREDICTORS OF EXTUBATION SUCCESS IN PATIENTS UNDERGOING ELECTIVE INTRACRANIAL SURGERY USING VISAGE SCORE AND IMPLICATIONS ON CLINICAL OUTCOME IN ICU

Abstract

Background: The decision to extubate patients undergoing intracranial surgeries holds a high degree of uncertainty of success as both anaesthesia and surgical maneuvers have a direct influence on the brain and its recovery. No guidelines for extubation exist in this category of the patient population.

Objective: The purpose was to study the predictors of extubation success in patients undergoing elective intracranial surgery, validation of VISAGE score in predicting extubation success and implications of extubation failure/postoperative mechanical ventilation on clinical outcome in ICU.

Study design: Prospective observational study

Participants: Patients aged 18 - 65 undergoing elective intracranial surgery from October 2017 to June 2019 were enrolled in the study.

Methods: 207 patients were enrolled for the study and stratified according to whether extubation was attempted in the operating room (early extubation) or in ICU (delayed extubation) .

Results: 118 (72.9%) patients underwent early extubation and 89 (27.1%) patients underwent delayed extubation. VISAGE score ≥3 predicted extubation success with a sensitivity of 71.3%, specificity of 47.1%, the positive predictive value of 88.9%, the negative predictive value of 21.6%, and p value of 0.041 which was statistically significant and final area under the curve was 0.635 (95% CI, 0.541-0.721). Higher VISAGE score was associated with lesser postoperative complications, shorter ICU stays, shorter hospital stay and higher GCS at the time of discharge from the hospital.

Conclusions: VISAGE score increases the probability of successful extubation in patients undergoing brain tumour surgeries. Further studies are needed to validate VISAGE score externally in large multicentres in prospective fashion to develop extubation guidelines in brain tumour surgeries.

Implications: VISAGE score is a simple clinical rule combining of four variables which helps in predicting and permitting successful extubation in neurosurgical patients.