Extubation protocol in critically Ill patients: evidencebased strategies for a tertiary Public Hospital in the Federal District

Introduction: Extubation in intensive care units (ICUs) is a complex process with a high failure rate and significant impact on clinical outcomes. In a public tertiary hospital in the Federal District, the lack of a standardized protocol results in variations in procedures and risks to patients. The literature highlights the importance of standardization to reduce complications and mortality. Objective: Propose an institutional extubation protocol for critically ill patients in the Intensive Care Units of a public hospital in the Federal District, aiming at standardizing the criteria, conduct and care involved in this procedure. Methodology: This study consisted of a narrative review of literature with a qualitative approach. The bibliographic search was conducted in the PubMed, Scielo and Embase databases. The study was structured in three main stages: survey and analysis of the scientific literature; comparison between the current recommendations found in the literature and the extubation practices adopted in the hospital's ICUs, based on analysis of institutional documents; proposal of an institutional extubation protocol based on the verified results. Results: Evidence suggests that factors such as a positive fluid balance, the presence of abundant secretions, advanced age, and compromised nutritional status increase the risk of extubation failure. Studies show that structured and standardized protocols, including functional testing and multidisciplinary management, increase the extubation success rate, especially in surgical and neurocritical patients. Corticosteroid prophylaxis, primarily dexamethasone and methylprednisolone, has been shown to reduce post-extubation complications. Furthermore, early extubation, when clinically feasible, is associated with better outcomes. These findings supported the proposal of an institutional protocol to standardize criteria, procedures, and care for extubation in ICUs. Conclusion: Based on the study, it is possible to conclude that there are significant variations and gaps in extubation practices across the hospital's ICUs, which reinforces the need for a standardized institutional protocol. The literature review highlighted evidence-based criteria and practices that can be adapted to local circumstances, and the analysis of available resources demonstrated the feasibility of implementing a unified protocol that promotes greater safety, uniformity, and quality in the care of critically ill patients.