To investigate and analyze the related factors of planned extubation failure in patients with severe brain injury treated with tracheal intubation. Methods: Clinical data and related factors of extubation results were collected on NICU patients who underwent tracheal intubation, experienced a >48 h intubation time, and underwent extubation. The difference between extubation success group and failure group was compared, and the risk factors of extubation were analyzed. Results: A total of 108 cases were collected with 19 cases of planned extubation failure and 89 cases of success. The difference in Glasgow coma scale （GCS）score, mechanical ventilation time, rapid shallow breathing index, and cough reflex between the two groups showed statistical significance（P<0.05）. Conclusion: GCS score, mechanical ventilation time, rapid shallow breathing index, and cough reflex are possible related determinant factors that influence the outcome of extubation