Extubation in neurocritical care patients: the ENIO international prospective study

Raphaël Cinotti^{1

2}, Julio Cesar Mijangos^{3

4}, Paolo Pelosi^{5

6}, Matthias Haenggi⁷, Mohan Gurjar⁸, Marcus J Schultz^{9

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; 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

Collaborators, Affiliations

Collaborators

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, Anaïs Codorniu, Giuseppe Citerio, Vittoria Ludovica Sala, Marinella Astuto, Eleonora Tringali, Daniela Alampi, Monica Rocco, Jessica Giuseppina Maugeri, Agrippino Bellissima, Matteo Filippini, Nicoletta Lazzeri, Andrea Cortegiani, Mariachiara Ippolito, Chiara Robba, Denise Battaglini, Patrick Biston, Mohamed Fathi Al-Gharyani, Russell Chabanne, Léo Astier, Benjamin Soyer, Samuel Gaugain, Alice Zimmerli, Urs Pietsch, Miodrag Filipovic, Giovanna Brandi, Giulio Bicciato, Ainhoa Serrano, Berta Monleon, Peter van Vliet, Benjamin Marcel Gerretsen, Iris Xochitl Ortiz-Macias, Jun Oto, Noriya Enomoto, Tomomichi Matsuda, Nobutaka Masui, Pierre Garçon, Jonathan Zarka, Wytze J Vermeijden, Alexander Daniel Cornet, Sergio Reyes Inurrigarro, Rafael Cirino Lara Domínguez, Maria Mercedes Bellini, Maria Milagros Gomez Haedo, Laura Lamot, Jose Orquera, Matthieu Biais, Delphine Georges, Arvind Baronia, Roberto Carlos Miranda-Ackerman, Francisco José Barbosa-Camacho, John Porter, Miguel Lopez-Morales, Thomas Geeraerts, Baptiste Compagnon, David Pérez-Torres, Estefanía Prol-Silva, Hana Basheer Yahya, Ala Khaled, Mohamed Ghula, Cracchiolo Neville Andrea, Palma Maria Daniela, Cristian Deana, Luigi Vetrugno, Manuel J Rivera Chavez, Rocio Mendoza Trujillo, Vincent Legros, Benjamin Brochet, Olivier Huet, Marie Geslain, Mathieu van der Jagt, Job van Steenkiste, Hazem Ahmed, Alexander Edward Coombs, Jessie Welbourne, Ana Alicia Velarde Pineda, Víctor Hugo Nubert Castillo, Mohammed A Azab, Ahmed Y Azzam, David Michael Paul van Meenen, Gilberto Adrian Gasca, Alfredo Arellano, Forttino Galicia-Espinosa, José Carlos García-Ramos, Ghanshyam Yadav, Amarendra Kumar Jha, Vincent Robert-Edan, Pierre-Andre Rodie-Talbere, Gaurav Jain, Sagarika Panda, Sonika Agarwal, Yashbir Deewan, Gilberto Adrian Gasca, Alfredo Arellano, Syed Tariq Reza, Md Mozaffer Hossain, Christos Papadas, Vasiliki Chantziara, Chrysanthi Sklavou, Yannick Hourmant, Nicolas Grillot, Job van Steenkiste, Mathieu van der Jagt, Romain Pirracchio, Abdelraouf Akkari, Mohamed Abdelaty, Ahmed Hashim, Yoann Launey, Elodie Masseret, Sigismond Lasocki, Soizic Gergaud, Nicolas Mouclier, Sulekha Saxena, Avinash Agrawal, Shakti Bedanta Mishra, Samir Samal

Affiliations

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.

PMID: 36038713
DOI: 10.1007/s00134-022-06825-8

Observational Study

Extubation in neurocritical care patients: the ENIO international prospective study

Raphaël Cinotti et al. Intensive Care Med. 2022 Nov.

. 2022 Nov;48(11):1539-1550.

doi: 10.1007/s00134-022-06825-8. Epub 2022 Aug 29.

Authors

Collaborators

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, Anaïs Codorniu, Giuseppe Citerio, Vittoria Ludovica Sala, Marinella Astuto, Eleonora Tringali, Daniela Alampi, Monica Rocco, Jessica Giuseppina Maugeri, Agrippino Bellissima, Matteo Filippini, Nicoletta Lazzeri, Andrea Cortegiani, Mariachiara Ippolito, Chiara Robba, Denise Battaglini, Patrick Biston, Mohamed Fathi Al-Gharyani, Russell Chabanne, Léo Astier, Benjamin Soyer, Samuel Gaugain, Alice Zimmerli, Urs Pietsch, Miodrag Filipovic, Giovanna Brandi, Giulio Bicciato, Ainhoa Serrano, Berta Monleon, Peter van Vliet, Benjamin Marcel Gerretsen, Iris Xochitl Ortiz-Macias, Jun Oto, Noriya Enomoto, Tomomichi Matsuda, Nobutaka Masui, Pierre Garçon, Jonathan Zarka, Wytze J Vermeijden, Alexander Daniel Cornet, Sergio Reyes Inurrigarro, Rafael Cirino Lara Domínguez, Maria Mercedes Bellini, Maria Milagros Gomez Haedo, Laura Lamot, Jose Orquera, Matthieu Biais, Delphine Georges, Arvind Baronia, Roberto Carlos Miranda-Ackerman, Francisco José Barbosa-Camacho, John Porter, Miguel Lopez-Morales, Thomas Geeraerts, Baptiste Compagnon, David Pérez-Torres, Estefanía Prol-Silva, Hana Basheer Yahya, Ala Khaled, Mohamed Ghula, Cracchiolo Neville Andrea, Palma Maria Daniela, Cristian Deana, Luigi Vetrugno, Manuel J Rivera Chavez, Rocio Mendoza Trujillo, Vincent Legros, Benjamin Brochet, Olivier Huet, Marie Geslain, Mathieu van der Jagt, Job van Steenkiste, Hazem Ahmed, Alexander Edward Coombs, Jessie Welbourne, Ana Alicia Velarde Pineda, Víctor Hugo Nubert Castillo, Mohammed A Azab, Ahmed Y Azzam, David Michael Paul van Meenen, Gilberto Adrian Gasca, Alfredo Arellano, Forttino Galicia-Espinosa, José Carlos García-Ramos, Ghanshyam Yadav, Amarendra Kumar Jha, Vincent Robert-Edan, Pierre-Andre Rodie-Talbere, Gaurav Jain, Sagarika Panda, Sonika Agarwal, Yashbir Deewan, Gilberto Adrian Gasca, Alfredo Arellano, Syed Tariq Reza, Md Mozaffer Hossain, Christos Papadas, Vasiliki Chantziara, Chrysanthi Sklavou, Yannick Hourmant, Nicolas Grillot, Job van Steenkiste, Mathieu van der Jagt, Romain Pirracchio, Abdelraouf Akkari, Mohamed Abdelaty, Ahmed Hashim, Yoann Launey, Elodie Masseret, Sigismond Lasocki, Soizic Gergaud, Nicolas Mouclier, Sulekha Saxena, Avinash Agrawal, Shakti Bedanta Mishra, Samir Samal

Affiliations

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.

PMID: 36038713
DOI: 10.1007/s00134-022-06825-8

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.

Keywords: Brain injury; Extubation; Intra-cranial haemorrhage; Tracheostomy; Traumatic brain injury.

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Comment in

Extubation failure in patients with acute brain injury: a major problem still awaiting a solution.
Bösel J, Rabinstein AA. Bösel J, et al. Intensive Care Med. 2022 Nov;48(11):1611-1613. doi: 10.1007/s00134-022-06856-1. Epub 2022 Aug 25. Intensive Care Med. 2022. PMID: 36008732 No abstract available.
Extubation in neurocritical care patients: lesson learned.
Cinotti R, Citerio G, Asehnoune K. Cinotti R, et al. Intensive Care Med. 2023 Feb;49(2):230-232. doi: 10.1007/s00134-022-06907-7. Epub 2022 Oct 17. Intensive Care Med. 2023. PMID: 36253548 No abstract available.
Building a better machine learning model of extubation for neurocritical care patients.
Ono S. Ono S. Intensive Care Med. 2023 Jan;49(1):119-120. doi: 10.1007/s00134-022-06922-8. Epub 2022 Nov 5. Intensive Care Med. 2023. PMID: 36334116 No abstract available.

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Extubation in neurocritical care patients: the ENIO international prospective study

Collaborators

Affiliations

Extubation in neurocritical care patients: the ENIO international prospective study

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