Abstract
Original language | English |
---|---|
Pages (from-to) | 1539-1550 |
Number of pages | 12 |
Journal | Intensive care medicine |
Volume | 48 |
Issue number | 11 |
DOIs | |
Publication status | Published - 1 Nov 2022 |
Keywords
- Brain injury
- Extubation
- Intra-cranial haemorrhage
- Tracheostomy
- Traumatic brain injury
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In: Intensive care medicine, Vol. 48, No. 11, 01.11.2022, p. 1539-1550.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Extubation in neurocritical care patients
T2 - the ENIO international prospective study
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 - 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 - Fong, Nicholas
AU - Asehnoune, Karim
N1 - Funding Information: The team is grateful to Mathilde Livic and Zeineb Lamoureux for their help in the administrative and juridic process with the centres and to Tanguy Roman, data manager, in the elaboration and handling of the database. The team is also grateful for all the research staff at the centres worldwide. Role of the funding source: the university hospital of Nantes France, elaborated the e-CRF. The sponsor took no part in the recruitment of centres, inclusions of patients, analysis of the results or writing of the article. Members 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: Paër-sélim Abback (Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP–HP.Nord, Paris, France.), Anaïs Codorniu (Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP–HP.Nord, Paris, France.), Giuseppe Citerio (Neurointensive Care Unit, Ospedale San Gerardo), Vittoria Ludovica Sala (NeuroIntensive care unit), Marinella Astuto (Anesthesia and Intensive Care Unit, A.O.U. Policlinico “G. Rodolico - S. Marco”), Eleonora Tringali (Anesthesia and Intensive Care Unit, A.O.U. Policlinico “G. Rodolico - S. Marco”), Daniela Alampi (Sapienza Rome University, A.O.U. Sant'Andrea), Monica Rocco (Sapienza Rome University, A.O.U. Sant'Andrea), Jessica Giuseppina Maugeri (Arnas Garibaldi Catania), Agrippino Bellissima (Arnas Garibaldi Catania), Matteo Filippini (University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy), Nicoletta Lazzeri (University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy), Andrea Cortegiani (Policlinico Paolo Giaccone, Università degli Studi di Palermo), Mariachiara Ippolito (Policlinico Paolo Giaccone, Università degli Studi di Palermo), Chiara Robba (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences -), Denise Battaglini (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences -), Patrick Biston (CHU Charleroi- Hôpital Civil Marie-Curie), Mohamed Fathi Al-Gharyani (Benghazi Medical Center), Russell Chabanne (Clermont-Ferrand University Hospital, Neurocritical Care Unit, Perioperative Medicine Department), Léo Astier (Clermont-Ferrand University Hospital, Neurocritical Care Unit, Perioperative Medicine Department), Benjamin Soyer (AP–HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care, DMU Parabol, Paris, France), Samuel Gaugain (AP–HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care, DMU Parabol, Paris, France), Alice Zimmerli (Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern), Urs Pietsch (Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St Gallen), Miodrag Filipovic (Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St Gallen), Giovanna Brandi (Institute for Intensive Care Medicine, University Hospital of Zurich), Giulio Bicciato (Institute for Intensive Care Medicine, University Hospital of Zurich), Ainhoa Serrano (Hospital Clinico Universitario Valencia), Berta Monleon (Hospital Clinico Universitario Valencia), Peter van Vliet (Haaglanden Medical Center), Benjamin Marcel Gerretsen (Haaglanden Medical Center), Iris Xochitl Ortiz-Macias (Hospital Civil de Guadalajara "Fray Antonio Alcalde"), Jun Oto (Tokushima University Hospital), Noriya Enomoto (Tokushima Prefectural Central Hospital), Tomomichi Matsuda (Sapporo Higashi Tokushukai Hospital), Nobutaka Masui (Sapporo Higashi Tokushukai Hospital), Pierre Garçon (Service de réanimation), Jonathan Zarka (Service de réanimation), Wytze J Vermeijden (Dep of intensive care, Medisch Spectrum Twente MST, Enschede, the Netherlands), Alexander Daniel Cornet (Dep of intensive care, Medisch Spectrum Twente MST, Enschede, the Netherlands), Sergio Reyes Inurrigarro (UMAE Hospital de Traumatologia y Ortopedia IMSS), Rafael Cirino Lara Domínguez (UMAE Hospital de Traumatologia y Ortopedia IMSS), Maria Mercedes Bellini (Hospital Maciel), Maria Milagros Gomez Haedo (Hospital Maciel), Laura Lamot (Hospital Municipal Leonidas Lucero), Jose Orquera (Sanatorio Pasteur), Matthieu Biais (Pellegrin SAR Tripode), Delphine Georges (Pellegrin SAR Tripode), Arvind Baronia (Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow), Roberto Carlos Miranda-Ackerman (Hospital San Javier), Francisco José Barbosa-Camacho (Hospital San Javier), John Porter (St George's Hospital), Miguel Lopez-Morales (St George's Hospital), Thomas Geeraerts (Toulouse University Hospital), Baptiste Compagnon (Toulouse University Hospital), David Pérez-Torres (Servicio de Medicina Intensiva, Hospital Universitario Río Hortega), Estefanía Prol-Silva (Servicio de Medicina Intensiva, Hospital Universitario Río Hortega), Hana Basheer Yahya (Zliten medical centre), Ala Khaled (Abo Selim Trauma Hospital), Mohamed Ghula (Abo Selim Trauma Hospital), Cracchiolo Neville Andrea (Terapia Intensiva Con Trauma Center Arnas Ospedale Civico Palermo), Palma Maria Daniela (Terapia Intensiva Con Trauma Center Arans Ospedale Civico Palermo), Cristian Deana (Academic Hospital of Udine), Luigi Vetrugno (University of Chieti-Pescara), Manuel J. Rivera Chavez (Hospital de Alta Especialidad del Bajio), Rocio Mendoza Trujillo (Hospital de Alta Especialidad del Bajio), Vincent Legros (Department of Anesthesiology and Critical Care, University Hospital of Reims), Benjamin Brochet (Department of Anesthesiology and Critical Care, University Hospital of Reims), Olivier Huet (Department of Anesthesiology and Critical Care, La Cavale Blanche), Marie Geslain (Department of Anesthesiology and Critical Care, La Cavale Blanche), Mathieu van der Jagt (Erasmus MC Rotterdam), Job van Steenkiste (Erasmus MC Rotterdam), Hazem Ahmed (Seoul Clinic), Alexander Edward Coombs (University Hospital Plymouth), Jessie Welbourne (University Hospital Plymouth), Ana Alicia Velarde Pineda (Hospital General Regional # 180 IMSS), Víctor Hugo Nubert Castillo (Hospital General Regional # 180 IMSS), Mohammed A Azab (Cairo University), Ahmed Y Azzam (Cairo University), David Michael Paul van Meenen (Amsterdam UMC), Gilberto Adrian Gasca (Hospital Regional de Alta Especialidad de Ixtapaluca), Alfredo Arellano (Hospital Regional de Alta Especialidad de Ixtapaluca), Forttino Galicia-Espinosa (UMAE Hospital de Traumatología y Ortopedia No 21, IMSS Monterrey), José Carlos García-Ramos (UMAE Hospital de Traumatología y Ortopedia No 21, IMSS Monterrey), Ghanshyam Yadav (Trauma ICU, Department of Anesthesia, IMS, BHU), Amarendra Kumar Jha (Trauma ICU, Department of Anesthesia, IMS, BHU), Vincent Robert-Edan (Department of Anaesthesia and critical care, Laennec, Nantes), Pierre-Andre Rodie-Talbere (Department of Anaesthesia and critical care, Laennec, Nantes), Gaurav Jain (Critical Care Unit, Dept. Of Anaesthesiology and Critical Care, All India Institute of Medical Sciences Rishikesh), Sagarika Panda (Critical Care Unit, Dept. Of Anaesthesiology and Critical Care, All India Institute of Medical Sciences Rishikesh), Sonika Agarwal (HIMS), Yashbir Deewan (HIMS), Gilberto Adrian Gasca (Hospital Regional de Alta Especialidad de Ixtapaluca), Alfredo Arellano (Hospital Regional de Alta Especialidad de Ixtapaluca), Syed Tariq Reza (Dhaka Medical College Hospital), Md. Mozaffer Hossain (Dhaka Medical College Hospital), Christos Papadas (ICU of ASKLEPIEIO G.H.A), Vasiliki Chantziara (SAINT SAVVAS hospital), Chrysanthi Sklavou (SAINT SAVVAS hospital), Yannick Hourmant (Department of Anesthesiology and Critical Care, Hôtel-Dieu, Nantes, France), Nicolas Grillot (Department of Anesthesiology and Critical Care, Hôtel-Dieu, Nantes, France), Romain Pirracchio (Department of Anesthesia and Perioperative Care, University of California, UCSF), Abdelraouf Akkari (Qatar-1), Mohamed Abdelaty (Qatar-2), Ahmed Hashim (Qatar-2), Yoann Launey (Department of Anesthesiology and Critical Care, Hopital Pontchaillou, France), Elodie Masseret (Department of Anesthesiology and Critical Care, Hopital Pontchaillou, France), Sigismond Lasocki (Department of Anesthesiology and Critical Care, Angers, France), Soizic Gergaud (Department of Anesthesiology and Critical Care, Angers, France), Nicolas Mouclier (Department of Anesthesiology and Critical Care, Hôtel-Dieu, Nantes, France), Sulekha Saxena (King George's Medical University), Avinash Agrawal (King George's Medical University), Shakti Bedanta Mishra (IMS and SUM Hospital), Samir Samal (IMS and SUM Hospital). Publisher Copyright: © 2022, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/11/1
Y1 - 2022/11/1
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 - http://www.scopus.com/inward/record.url?scp=85136883213&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00134-022-06825-8
DO - https://doi.org/10.1007/s00134-022-06825-8
M3 - Article
C2 - 36038713
SN - 0342-4642
VL - 48
SP - 1539
EP - 1550
JO - Intensive care medicine
JF - Intensive care medicine
IS - 11
ER -