Raphaël Cinotti1,2, Julio Cesar Mijangos3,4, Paolo Pelosi5,6, Matthias Haenggi7, Mohan Gurjar8, Marcus J Schultz9,10,11, Callum Kaye12, Daniel Agustin Godoy13, Pablo Alvarez14, Aikaterini Ioakeimidou15, Yoshitoyo Ueno16, Rafael Badenes17, Abdurrahmaan Ali Suei Elbuzidi18, Michaël Piagnerelli19, Muhammed Elhadi20, Syed Tariq Reza21, Mohammed Atef Azab22, Victoria McCredie23, Robert D Stevens24, Jean Catherine Digitale25, Nicholas Fong26, Karim Asehnoune27. 1. Department of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, 44000, Nantes, France. 2. UMR 1246 SPHERE "MethodS in Patients-Centered Outcomes and HEalth Research", University of Nantes, University of Tours, INSERM, IRS2 22 Boulevard Benoni Goulin, 44200, Nantes, France. 3. Hospital Civil de Guadalajara "Fray Antonio Alcalde", Hospital No. 278, Col. El Retiro 44280, Guadalajara, Mexico. 4. División de Disciplinas Clínicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico. 5. IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Largo Rosanna Benzi 10, 16100, Genoa, Italy. 6. Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy. 7. Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. 8. Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India. 9. Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', 1105 AZ, Amsterdam, The Netherlands. 10. Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand. 11. Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, OX3 7LG, UK. 12. Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK. 13. Sanatorio Pasteur, Chacabuco 675, 4700, Catamarca, Argentina. 14. Hospital Maciel, ASSE, Street 25 de Mayo 174, 11000, Montevideo, Uruguay. 15. Department of Critical Care Medicine of Asklepieio G.H.A, V.Paulou 1, 16673, Athens, Greece. 16. Tokushima University Hospital, 2-50-1, Kuramotocho, Tokushima, 7700042, Japan. 17. Department of Anesthesiology and Surgical-Trauma Intensive Care, Department of Surgery, Hospital Clínico Universitario Valencia, University of Valencia, Valencia, Spain. 18. Qatar-1, Hamad Medical Corporation, Doha, Qatar. 19. CHU Charleroi-Hôpital Civil Marie-Curie, Université libre de Bruxelles, 140 Chaussée de Bruxelles, Lodelinsart, 6042, Charleroi, Belgium. 20. Faculty of Medicine, University of Tripoli, Furnaj, University Road, 13275, Tripoli, Libya. 21. Department of Anaesthesia, Analgesia, Palliative and Intensive Care, Dhaka Medical College Hospital, Dhaka, 1000, Bangladesh. 22. Cairo University, Giza, 12613, Egypt. 23. Toronto Western Hospital-University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada. 24. Department of Anesthesiology and Critical Care, John Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA. 25. Department of Epidemiology and Biostatistics, University of California, UCSF, 550 16th St, San Francisco, CA, 94158, USA. 26. Department of Anesthesia and Perioperative Care, University of California, UCSF, 1001 Potrero Ave, San Francisco, CA, 94110, USA. 27. Department of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, 44000, Nantes, France. karim.asehnoune@chu-nantes.fr.
Abstract
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.
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.
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