Uji Validasi Extubation Predictive Score (ExPreS) dan Skor VISAGE sebagai Prediktor Keberhasilan Ekstubasi pada Pasien Neurocritical dengan Penggunaan Ventilator Mekanik di ruang Intensive Care Unit Rumah Sakit Umum Pusat Haji Adam Malik Medan dan Rumah Sakit Jejaring

Abstract

Introduction: Extubation failure in neurocritical patients is associated with poor outcomes. Reintubation and reinsertion of invasive mechanical ventilators may be associated with worse outcomes not only because of possible complications of the process, but to a large extent, because patients who fail extubation may have worse clinical conditions. Hence the importance of instruments that can properly identify patients who are likely to have successful extubation.

Aim: To determine the predictive value of Extubation Predictive Score (ExPreS) and VISAGE score as predictors of successful extubation in neurocritical patients with mechanical ventilator use admitted to the Intensive Care Unit..

Method: This study was a prospective cohort study of neurocritical patients attending the Intensive Care Unit of H. Adam Malik Central General Hospital and network hospitals from July to December 2024. We assessed the predictive score of successful extubation using VISAGE score and Extubation Predictive Score (ExPreS). Successful extubation was defined as reintubation, use of mechanical ventilator after spontaneous breathing test (SBT) within 48 hours.

Result: There were 56 subjects with the majority of subjects male, aged > 40 years with a mean age of 48.9 ± 16.5 years, senior high school education level, not unemployed, with a diagnosis of traumatic brain injury. Both predictive scores of extubation success in this study can be used to predict the successful extubation of neurocritical patients in the Intensive Care Unit with p < 0.001 and AUC > 0.8 which indicates a good value. The sensitivity value of ExPreS was 89.5%, specificity 88.9% and AUC 0.945, while the sensitivity value of VISAGE score was 63.2%, specificity 94.4%, and AUC of 0.876.

Conclussion : VISAGE and ExPreS scores can predict extubation success in neurocritical patients. Evaluation with scores can be considered in every neurocritical patient on mechanical ventilator before extubation.

Keyword: Extubation Predictive Score (ExPreS), VISAGE score, neurocritical, extubation success