TY - JOUR
T1 - Extubation in neurocritical care patients
T2 - the ENIO international prospective study
AU - on behalf of the ENIO Study Group, the PROtective VENTilation network, the European Society of Intensive Care Medicine, the Colegio Mexicano de Medicina Critica, the Atlanréa group and the Société Française d’Anesthésie-Réanimation–SFAR research network
AU - Cinotti, Raphaël
AU - Mijangos, Julio Cesar
AU - Pelosi, Paolo
AU - Haenggi, Matthias
AU - Gurjar, Mohan
AU - Schultz, Marcus J.
AU - Kaye, Callum
AU - Godoy, Daniel Agustin
AU - Alvarez, Pablo
AU - Ioakeimidou, Aikaterini
AU - Ueno, Yoshitoyo
AU - Badenes, Rafael
AU - Suei Elbuzidi, Abdurrahmaan Ali
AU - Piagnerelli, Michaël
AU - Elhadi, Muhammed
AU - Reza, Syed Tariq
AU - Azab, Mohammed Atef
AU - McCredie, Victoria
AU - Stevens, Robert D.
AU - Digitale, Jean Catherine
AU - Fong, Nicholas
AU - Asehnoune, Karim
AU - Abback, Paër sélim
AU - Codorniu, Anaïs
AU - Citerio, Giuseppe
AU - Sala, Vittoria Ludovica
AU - Astuto, Marinella
AU - Tringali, Eleonora
AU - Alampi, Daniela
AU - Rocco, Monica
AU - Maugeri, Jessica Giuseppina
AU - Bellissima, Agrippino
AU - Filippini, Matteo
AU - Lazzeri, Nicoletta
AU - Cortegiani, Andrea
AU - Ippolito, Mariachiara
AU - Robba, Chiara
AU - Battaglini, Denise
AU - Biston, Patrick
AU - Al-Gharyani, Mohamed Fathi
AU - Chabanne, Russell
AU - Astier, Léo
AU - Soyer, Benjamin
AU - Gaugain, Samuel
AU - Zimmerli, Alice
AU - Pietsch, Urs
AU - Filipovic, Miodrag
AU - Brandi, Giovanna
AU - Bicciato, Giulio
AU - Welbourne, Jessie
N1 - Publisher Copyright:
© 2022, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/8/29
Y1 - 2022/8/29
N2 - Purpose: Neurocritical care patients receive prolonged invasive mechanical ventilation (IMV), but there is poor specific information in this high-risk population about the liberation strategies of invasive mechanical ventilation. Methods: ENIO (NCT03400904) is an international, prospective observational study, in 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Neurocritical care patients with a Glasgow Coma Score (GCS) ≤ 12, receiving IMV ≥ 24 h, undergoing extubation attempt or tracheostomy were included. The primary endpoint was extubation failure by day 5. An extubation success prediction score was created, with 2/3 of patients randomly allocated to the training cohort and 1/3 to the validation cohort. Secondary endpoints were the duration of IMV and in-ICU mortality. Results: 1512 patients were included. Among the 1193 (78.9%) patients who underwent an extubation attempt, 231 (19.4%) failures were recorded. The score for successful extubation prediction retained 20 variables as independent predictors. The area under the curve (AUC) in the training cohort was 0.79 95% confidence interval (CI95) [0.71–0.87] and 0.71 CI95 [0.61–0.81] in the validation cohort. Patients with extubation failure displayed a longer IMV duration (14 [7–21] vs 6 [3–11] days) and a higher in-ICU mortality rate (8.7% vs 2.4%). Three hundred and nineteen (21.1%) patients underwent tracheostomy without extubation attempt. Patients with direct tracheostomy displayed a longer duration of IMV and higher in-ICU mortality than patients with an extubation attempt (success and failure). Conclusions: In neurocritical care patients, extubation failure is high and is associated with unfavourable outcomes. A score could predict extubation success in multiple settings. However, it will be mandatory to validate our findings in another prospective independent cohort.
AB - Purpose: Neurocritical care patients receive prolonged invasive mechanical ventilation (IMV), but there is poor specific information in this high-risk population about the liberation strategies of invasive mechanical ventilation. Methods: ENIO (NCT03400904) is an international, prospective observational study, in 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Neurocritical care patients with a Glasgow Coma Score (GCS) ≤ 12, receiving IMV ≥ 24 h, undergoing extubation attempt or tracheostomy were included. The primary endpoint was extubation failure by day 5. An extubation success prediction score was created, with 2/3 of patients randomly allocated to the training cohort and 1/3 to the validation cohort. Secondary endpoints were the duration of IMV and in-ICU mortality. Results: 1512 patients were included. Among the 1193 (78.9%) patients who underwent an extubation attempt, 231 (19.4%) failures were recorded. The score for successful extubation prediction retained 20 variables as independent predictors. The area under the curve (AUC) in the training cohort was 0.79 95% confidence interval (CI95) [0.71–0.87] and 0.71 CI95 [0.61–0.81] in the validation cohort. Patients with extubation failure displayed a longer IMV duration (14 [7–21] vs 6 [3–11] days) and a higher in-ICU mortality rate (8.7% vs 2.4%). Three hundred and nineteen (21.1%) patients underwent tracheostomy without extubation attempt. Patients with direct tracheostomy displayed a longer duration of IMV and higher in-ICU mortality than patients with an extubation attempt (success and failure). Conclusions: In neurocritical care patients, extubation failure is high and is associated with unfavourable outcomes. A score could predict extubation success in multiple settings. However, it will be mandatory to validate our findings in another prospective independent cohort.
KW - Brain injury
KW - Extubation
KW - Intra-cranial haemorrhage
KW - Tracheostomy
KW - Traumatic brain injury
UR - https://www.scopus.com/pages/publications/85136883213
U2 - 10.1007/s00134-022-06825-8
DO - 10.1007/s00134-022-06825-8
M3 - Article
C2 - 36038713
AN - SCOPUS:85136883213
SN - 0342-4642
VL - 48
SP - 1539
EP - 1550
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 11
ER -