Risk factors for failed extubation within 7 days in elderly critically ill patients based on respiratory mechanics and clinical indicators: a retrospective cohort study.

Background: Tracheal intubation and mechanical ventilation are common treatments for critically ill patients. Extubation failure is associated with prolonged mechanical ventilation, increased incidence of ventilator-associated pneumonia (VAP), and elevated mortality. Elderly patients face unique challenges. Thus, early risk assessment for weaning and extubation in elderly patients is crucial. This study aimed to identify independent risk factors for extubation failure within 7 days in elderly critically ill patients. Methods: A retrospective cohort study was conducted on 103 elderly patients with tracheal intubation admitted to our ICU from January 2022 to July 2025. Clinical characteristics of patients with extubation failure within 7 days were analyzed. The optimal cutoff values for continuous variables were determined using the Youden index. Logistic regression analysis was performed to identify independent risk factors for extubation failure within 7 days. Results: There was a high rate of extubation failure within 7 days in elderly critically ill patients. Logistic regression showed that female (OR = 6.770, 95% CI 1.100-41.654, p = 0.039), serum sodium >145.76 mmol/L (OR = 15.008, 95% CI 1.189-189.465, p = 0.036), lactate >3.45 mmol/L (OR = 17.866, 95% CI 1.907-167.378, p = 0.012), and peak airway pressure (Ppeak) > 18.5 cmH₂O (OR = 9.056, 95% CI 1.705-48.111, p = 0.010) were positively correlated with extubation failure, serving as independent risk factors. Conclusion: Female, serum sodium >145.76 mmol/L, lactate >3.45 mmol/L at intubation, and Ppeak >18.5 cmH₂O at relative stability after intubation are independent risk factors for extubation failure within 7 days in elderly patients with tracheal intubation.