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Observational Study
. 2024 Aug 1;52(8):1258-1263.
doi: 10.1097/CCM.0000000000006283. Epub 2024 Apr 1.

Evaluating the Sum of Eye and Motor Components of the Glasgow Coma Score As a Predictor of Extubation Failure in Patients With Acute Brain Injury

Shaurya Taran  1 , Bastien Perrot  2 , Federico Angriman  1   3 , Raphael Cinotti  2   4 ; Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes (ENIO) Study Group; PROtective VENTilation network; European Society of Intensive Care Medicine; Colegio Mexicano de Medicina Critica; Atlanréa group, and the Société Française d’Anesthésie et de Réanimation (SFAR) research network; Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes (ENIO) Study Group and PROtective VENTilation network and the European Society of Intensive Care Medicine and the Colegio Mexicano de Medicina Critica and the Atlanréa group, and the Société Française d’Anesthésie et de Réanimation (SFAR) research network
Collaborators, Affiliations
Observational Study

Evaluating the Sum of Eye and Motor Components of the Glasgow Coma Score As a Predictor of Extubation Failure in Patients With Acute Brain Injury

Shaurya Taran et al. Crit Care Med. .

Abstract

Objectives: To evaluate the association between the pre-extubation sum of eye and motor components of the Glasgow Coma Score (GCS-EM) and odds of extubation failure in patients with acute brain injury being liberated from mechanical ventilation.

Design: Secondary analysis of a prospective, multicenter observational study ( ClinicalTrials.gov identifier NCT03400904).

Setting: Sixty-three hospital sites worldwide, with patient recruitment from January 2018 to November 2020.

Patients: One thousand one hundred fifty-two critically ill patients with acute brain injury, with a median age of 54 years, of whom 783 (68.0%) were male, 559 (48.5%) had traumatic brain injury, and 905 (78.6%) had a GCS-EM greater than 8 before extubation (scores range from 2 to 10).

Interventions: None.

Measurements and main results: GCS-EM was computed in intubated patients on the day of extubation. The main outcome was extubation failure, defined as unplanned reintubation within 5 days of extubation. Analyses used multilevel logistic regression with adjustment for patient characteristics and a random intercept for hospital site. In the primary analysis, GCS-EM was not associated with extubation failure (odds ratio, 1.07 per additional point; 95% CI, 0.87-1.31). Findings were consistent in sensitivity analyses that: 1) used different adjustment covariates, 2) included a verbal estimate to derive an overall GCS, 3) accounted for missing data, 4) considered a 2-day time interval to define extubation failure, 5) accounted for competing risks, and 6) used a propensity score-based model. There was no association between GCS-EM and extubation outcome in subgroups defined by brain injury diagnosis or age.

Conclusions: In this large, contemporary, multicenter cohort of patients with acute brain injury, we found no association between the GCS-EM and odds of extubation failure. However, few patients had a pre-extubation GCS-EM less than or equal to 8, and the possibility of a true prognostic association in patients with low scores is not excluded.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interests.

References

    1. Cinotti R, Mijangos JC, Pelosi P, et al.; 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: Extubation in neurocritical care patients: The ENIO international prospective study. Intensive Care Med. 2022; 48:1539–1550
    1. Taran S, Angeloni N, Pinto R, et al.: Prognostic factors associated with extubation failure in acutely brain-injured patients: A systematic review and meta-analysis. Crit Care Med. 2023; 51:401–412
    1. Asehnoune K, Seguin P, Lasocki S, et al.; ATLANREA group: Extubation success prediction in a multicentric cohort of patients with severe brain injury. Anesthesiology. 2017; 127:338–346
    1. McCredie VA, Ferguson ND, Pinto RL, et al.; Canadian Critical Care Trials Group: Airway management strategies for brain-injured patients meeting standard criteria to consider extubation. A prospective cohort study. Ann Am Thorac Soc. 2017; 14:85–93
    1. Coplin WM, Pierson DJ, Cooley KD, et al.: Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000; 161:1530–1536

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