Avaliação do checklist para extubação de pacientes adultos em ventilação mecânica invasiva

Abstract

Objective: To evaluate the success and failure of extubation in adult patients on invasive mechanical ventilation using a standardized checklist. Methods: Prospective observational study conducted in an intensive care unit, including 35 adult patients undergoing invasive mechanical ventilation for ≥24 hours and candidates for extubation, between March and October 2025. A structured checklist with 18 criteria stratified by priority levels (high, medium, and low) was applied, evaluating neurological, metabolic, respiratory, and hemodynamic parameters. The primary outcome was extubation success rate, defined as remaining in spontaneous ventilation for ≥48 hours. Mann-Whitney test was used for continuous variables and Fisher's exact test for categorical variables, with a significance level of 5%. Results: The extubation success rate was 88.6% (31/35) and failure rate was 11.4% (4/35). Although no individual criterion reached statistical significance, impaired level of consciousness was present in 100% of failures, followed by metabolic-fluid imbalances (inadequate potassium and positive fluid balance in 75%) and impaired cough (inadequate peak flow in 75%). The total checklist score showed clinically relevant difference between success and failure groups (13.7 ± 2.3 vs 12.0 ± 1.4 points; p=0.197). A cutoff point of ≥14 points is proposed as indicative of safety for extubation. Conclusion: The standardized 18-criteria checklist demonstrated high extubation success rate and enabled identification of modifiable risk factors, particularly neurological impairment, metabolic instability, and fluid overload. The stratified multiparametric approach proved to be a viable tool for optimizing safety in the extubation process in intensive care.