Extubation in neurocritical care patients: the ENIO international prospective study

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 ($ CI_{95} $) [0.71–0.87] and 0.71 $ CI_{95} $ [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..

Medienart:

E-Artikel

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

Zur Gesamtaufnahme - volume:48

Enthalten in:

Intensive care medicine - 48(2022), 11 vom: 29. Aug., Seite 1539-1550

Sprache:

Englisch

Beteiligte Personen:

Cinotti, Raphaël [VerfasserIn]
Mijangos, Julio Cesar [VerfasserIn]
Pelosi, Paolo [VerfasserIn]
Haenggi, Matthias [VerfasserIn]
Gurjar, Mohan [VerfasserIn]
Schultz, Marcus J. [VerfasserIn]
Kaye, Callum [VerfasserIn]
Godoy, Daniel Agustin [VerfasserIn]
Alvarez, Pablo [VerfasserIn]
Ioakeimidou, Aikaterini [VerfasserIn]
Ueno, Yoshitoyo [VerfasserIn]
Badenes, Rafael [VerfasserIn]
Suei Elbuzidi, Abdurrahmaan Ali [VerfasserIn]
Piagnerelli, Michaël [VerfasserIn]
Elhadi, Muhammed [VerfasserIn]
Reza, Syed Tariq [VerfasserIn]
Azab, Mohammed Atef [VerfasserIn]
McCredie, Victoria [VerfasserIn]
Stevens, Robert D. [VerfasserIn]
Digitale, Jean Catherine [VerfasserIn]
Fong, Nicholas [VerfasserIn]
Asehnoune, Karim [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.69$jIntensivmedizin

Themen:

Brain injury
Extubation
Intra-cranial haemorrhage
Tracheostomy
Traumatic brain injury

RVK:

RVK Klassifikation

Anmerkungen:

© Springer-Verlag GmbH Germany, part of Springer Nature 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1007/s00134-022-06825-8

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2132477175

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