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. 2026 Jan 13.
doi: 10.1007/s00134-025-08258-5. Online ahead of print.

Spontaneous breathing trials as predictors of extubation outcomes in neurocritical care: insights from the ENIO study

Denise Battaglini  1   2 , Shaurya Taran  3   4 , Francesca Gualdi  5   6 , Raphael Cinotti  7 , Karim Asehnoune  7 , Andrea Loggini  8   9 , Luca Montagnani  10 , Patricia R M Rocco  11 , Marcus J Schultz  12   13   14   15 , Nicolò Antonino Patroniti  5   6 , Chiara Robba  5   6 ; ENIO Collaborators
Collaborators, Affiliations

Spontaneous breathing trials as predictors of extubation outcomes in neurocritical care: insights from the ENIO study

Denise Battaglini et al. Intensive Care Med. .

Abstract

Purpose: In critically ill patients, extubation readiness is typically assessed using a spontaneous breathing trial (SBT). Among patients with acute brain injury (ABI), the optimal SBT method remains uncertain.

Methods: We conducted a post-hoc analysis of the ENIO study (NCT03400904), including mechanically ventilated ABI patients with available SBT data, undergoing extubation attempt. SBTs were classified as T-piece, pressure support ventilation (PSV), or continuous positive airway pressure (CPAP). The primary outcome was extubation failure within 5 days. Associations between SBT modality and extubation failure were assessed using multivariable logistic regression and inverse probability of treatment weighting.

Results: Of 1,512 patients enrolled in ENIO, 839 met the inclusion criteria, of whom 270 (32.2%) were female and 396 (47.2%) had traumatic brain injury as the cause of admission. SBTs were performed with PSV in 430 (51.3%), T-piece in 329 (39.2%), and CPAP in 80 (9.5%). SBT median duration was 60 min in PSV and T-piece, while 120 min in CPAP. Extubation failure occurred in 177 (21.1%) cases. In multivariable analyses, there was no significant association between SBT modality or duration and extubation outcome. Results were similar in ABI subgroup analyses. After inverse probability weighting, vigorous cough remained the only significant predictor of extubation success.

Conclusions: In this large international ABI cohort, neither SBT mode nor duration was associated with extubation failure.

Keywords: Acute brain injury; Critically ill; Extubation; Mechanical ventilation; Spontaneous breathing trial; Weaning.

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Conflict of interest statement

Declarations. Conflicts of interest: DB lecturer fees from ESTOR, and CR lecturer fees from BD. CR is a Deputy Editor for Intensive Care Medicine. She has not taken part in the review or selection process of this article. Ethical approval: The study was initially approved by the Groupe Nantais d’Éthique dans le Domaine de la Santé (international review board approval no. 7/11/2017). Ethical approval was subsequently obtained at each participating center according to national and institutional requirements. Informed consent (oral and/or written) was obtained in accordance with local regulations. No further approval was required for this secondary analysis.

References

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