Portal de investigación
Extubation in neurocritical care patients: the ENIO international prospective study.
Autores de INCLIVA
Participantes ajenos a INCLIVA
- Cinotti, R
- Mijangos, JC
- Pelosi, P
- Haenggi, M
- Gurjar, M
- Schultz, MJ
- Kaye, C
- Godoy, DA
- Alvarez, P
- Ioakeimidou, A
- Ueno, Y
- Elbuzidi, AAS
- Piagnerelli, M
- Elhadi, M
- Reza, ST
- Azab, MA
- McCredie, V
- Stevens, RD
- Digitale, JC
- Fong, N
- Asehnoune, K
- ENIO Study Grp
- PROtective VENTilation Network
- European Soc Intensive Care Med
- Colegio Mexicano Med Critica
- Atlanrea Grp
- Soc Francaise Anesthesie-Reanimati
Grupos y Plataformas de I+D+i
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 (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.
© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.
Datos de la publicación
- ISSN/ISSNe:
- 0342-4642, 1432-1238
- Tipo:
- Article
- Páginas:
- 1539-1550
- PubMed:
- 36038713
INTENSIVE CARE MEDICINE SPRINGER
Citas Recibidas en Web of Science: 65
Documentos
- No hay documentos
Filiaciones
Keywords
- Brain injury; Extubation; Intra-cranial haemorrhage; Tracheostomy; Traumatic brain injury
Financiación
Cita
Extubation in neurocritical care patients: the ENIO international prospective study. Cinotti R, Mijangos JC, Pelosi P, Haenggi M, Gurjar M, Schultz MJ, Kaye C et al. INTENSIVE CARE MEDICINE. 2022 noviembre 01. 48 (11):1539-1550. DOI:10.1007/s00134-022-06825-8. PMID:36038713.
