Analysis of Risk Factors for Extubation Failure in Subjects Submitted to Non-Emergency Elective Intracranial Surgery

BACKGROUND: Extubation failure is defined as the re-institution of respiratory support ranging from 24 to 72 hours following scheduled extubation and occurs in 2% to 25% of extubated patients. the aim of this study was to determine clinical and surgical risk factors that may predict extubation failure in patients submitted to non-emergency intracranial surgery. METHODS: This was a prospective observational cohort study. the study was carried out on 317 subjects submitted to non-emergency intracranial surgery for tumors, aneurysms, and arteriovenous malformation. Preoperative assessment was performed and subjects were followed up for the determination of extubation failure until either discharge from hospital or death. RESULTS: Twenty-six (8.2%) of the 317 subjects experienced extubation failure following surgery. the following variables were considered for the multivariate analysis: level of consciousness at the time of extubation, duration of mechanical ventilation prior to extubation, sex and the use of intraoperative mannitol. the multivariate analysis determined that the most important variable for extubation failure was the level of consciousness at the time of extubation (P = .001), followed by female sex, which also showed to be significant (P = .006). CONCLUSIONS: Lower level of consciousness (GCS 8T-10T) and female sex were considered risk factors for extubation failure in subjects submitted to elective intracranial surgery.Universidade Federal de São Paulo, Disciplina Pneumol, Div Resp, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Physiotherapy, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurosurg, BR-04023062 São Paulo, BrazilEscola Super Ciencias Santa Casa Misericordia Vit, Dept Physiotherapy, Vitoria, Espirito Santo, BrazilUniversidade Federal de São Paulo, Disciplina Pneumol, Div Resp, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Physiotherapy, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurosurg, BR-04023062 São Paulo, BrazilWeb of Scienc

Outcome following lumbar disc surgery: the role of fibrosis

Failed-back surgery syndrome remains a challenge for spinal surgeons. It can be related to several causes, including poor surgical indication, misdiagnosis, surgical technique failure, spondilodiscitis and fibrosis. Fibrosis has been associated with a poorer outcome in lumbar disc surgery, although its role in the generation of symptoms is not yet clear. in this study, the authors have analyzed any possible correlation between the clinical outcome and the degree of fibrosis.Forty consecutive patients were enrolled in a prospective study. All of them had operations in the lower lumbar disc in a single level for the first time. Three months after the operation they were submitted to clinical outcome evaluations and questionnaires, including Numeric Pain Rating scales (NPR) for lumbar and leg pain, the McGill Pain Questionnaire, the Quebec Back Pain Disability scale (QBPD) and Straight Leg Raising test. These data were correlated with the degree of fibrosis as revealed by Magnetic Resonance Imaging (MRI).After 3 months, the NPR values for lumbar and leg pain ranged from 0 to 8 (mean 2.32 and 1.67 respectively). the values of the post-operative QBPD scale ranged from 1 to 71 (mean 25.9). Every patient showed a varied degree of fibrosis on MRI. However, statistical analysis depicted no significant correlation between fibrosis and a poorer clinical outcome for pain and disability.The authors found no correlation between excessive fibrosis with lumbar and leg pain, disability or straight leg resistance. the role of fibrosis in the generation of symptoms in patients who have had lumbar disc surgery should be reevaluated.Inst Neurol Curitiba, CINDOR, BR-80730060 Curitiba, Parana, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilCEDIP, Curitiba, Parana, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc