6533b823fe1ef96bd127eafb
RESEARCH PRODUCT
Extubation in neurocritical care patients: the ENIO international prospective study
Raphaël CinottiJulio Cesar MijangosPaolo PelosiMatthias HaenggiMohan GurjarMarcus J. SchultzCallum KayeDaniel Agustin GodoyPablo AlvarezAikaterini IoakeimidouYoshitoyo UenoRafael BadenesAbdurrahmaan Ali Suei ElbuzidiMichaël PiagnerelliMuhammed ElhadiSyed Tariq RezaMohammed Atef AzabVictoria MccredieRobert D. StevensJean Catherine DigitaleNicholas FongKarim AsehnounePaër-sélim AbbackAnaïs CodorniuGiuseppe CiterioVittoria Ludovica SalaMarinella AstutoEleonora TringaliDaniela AlampiMonica RoccoJessica Giuseppina MaugeriAgrippino BellissimaMatteo FilippiniNicoletta LazzeriAndrea CortegianiMariachiara IppolitoChiara RobbaDenise BattagliniPatrick BistonMohamed Fathi Al-gharyaniRussell ChabanneLéo AstierBenjamin SoyerSamuel GaugainAlice ZimmerliUrs PietschMiodrag FilipovicGiovanna BrandiGiulio BicciatoAinhoa SerranoBerta MonleonPeter Van VlietBenjamin Marcel GerretsenIris Xochitl Ortiz-maciasJun OtoNoriya EnomotoTomomichi MatsudaNobutaka MasuiPierre GarçonJonathan ZarkaWytze J. VermeijdenAlexander Daniel CornetSergio Reyes InurrigarroRafael Cirino Lara DomínguezMaria Mercedes BelliniMaria Milagros Gomez HaedoLaura LamotJose OrqueraMatthieu BiaisDelphine GeorgesArvind BaroniaRoberto Carlos Miranda-ackermanFrancisco José Barbosa-camachoJohn PorterMiguel Lopez-moralesThomas GeeraertsBaptiste CompagnonDavid Pérez-torresEstefanía Prol-silvaHana Basheer YahyaAla KhaledMohamed GhulaCracchiolo Neville AndreaPalma Maria DanielaCristian DeanaLuigi VetrugnoManuel J. Rivera ChavezRocio Mendoza TrujilloVincent LegrosBenjamin BrochetOlivier HuetMarie GeslainMathieu Van Der JagtJob Van SteenkisteHazem AhmedAlexander Edward CoombsJessie WelbourneAna Alicia Velarde PinedaVíctor Hugo Nubert CastilloMohammed A. AzabAhmed Y. AzzamDavid Michael Paul Van MeenenGilberto Adrian GascaAlfredo ArellanoForttino Galicia-espinosaJosé Carlos García-ramosGhanshyam YadavAmarendra Kumar JhaVincent Robert-edanPierre-andre Rodie-talbereGaurav JainSagarika PandaSonika AgarwalYashbir DeewanGilberto Adrian GascaAlfredo ArellanoSyed Tariq RezaMd. Mozaffer HossainChristos PapadasVasiliki ChantziaraChrysanthi SklavouYannick HourmantNicolas GrillotJob Van SteenkisteMathieu Van Der JagtRomain PirracchioAbdelraouf AkkariMohamed AbdelatyAhmed HashimYoann LauneyElodie MasseretSigismond LasockiSoizic GergaudNicolas MouclierSulekha SaxenaAvinash AgrawalShakti Bedanta MishraSamir Samalsubject
Intensive Care UnitsTracheostomyTraumatic brain injuryExtubationAirway ExtubationHumansProspective StudiesBrain injuryCritical Care and Intensive Care MedicineIntra-cranial haemorrhageRespiration Artificialdescription
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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2022-08-29 |