Dataset Information

Extubation strategies in neuro-intensive care unit patients and associations with outcomes: the ENIO multicentre international observational study.

ABSTRACT:

Background

Prolonged invasive ventilation is common in patients with severe brain injury. Information on optimal management of extubation and on the use of tracheostomy in these patients is scarce. International guidelines regarding the ventilator liberation and tracheostomy are currently lacking.

Methods

The aim of 'Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes' (ENIO) study is to describe current management of weaning from invasive ventilation, focusing on decisions on timing of tracheal extubation and tracheostomy in intensive care unit (ICU) patients with brain injury. We conducted a prospective, international, multi-centre observational study enrolling patients with various types of brain injury, including trauma, stroke, and subarachnoid haemorrhage, with an initial Glasgow Coma Score equal or less than 12, and a duration of invasive ventilation longer than 24 hours from ICU admission. ENIO is expected to include at least 1,500 patients worldwide. The primary endpoint of the ENIO study is extubation success in the 48 hours following endotracheal tube removal. The primary objective is to validate a score predictive of extubation success. To accomplish this, the study population will be randomly divided to a development cohort (2/3 of the included patients) and a validation cohort (the remaining 1/3). Secondary objectives are: to determine the incidence of extubation success rate according to various time-frames (within 96 hours, >96 hours after extubation); to validate (existing) prediction scores for successful extubation according to various time-frames and definitions (i.e., tracheostomy as extubation failure); and to describe the current practices of extubation and tracheostomy, and their associations.

Discussion

ENIO will be the largest prospective observational study of ventilator liberation and tracheostomy practices in patients with severe brain injury undergoing invasive mechanical ventilation, providing a validated predictive score of successful extubation.

Trial registration

The ENIO study is registered in the Clinical Trials database: NCT03400904.

SUBMITTER: Cinotti R

PROVIDER: S-EPMC7210208 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Publications

Extubation strategies in neuro-intensive care unit patients and associations with outcomes: the ENIO multicentre international observational study.

Cinotti Raphaël R Pelosi Paolo P Schultz Marcus J MJ Aikaterini Ioakeimidou I Alvarez Pablo P Badenes Rafael R Mc Credie Victoria V Elbuzidi Abdurrahmaan Suei AS Elhadi Muhammed M Godoy Daniel Agustin DA Gurjar Mohan M Haenggi Matthias M Kaye Callum C Mijangos-Méndez Julio Cesar JC Piagnerelli Michael M Piracchio Romain R Reza Syed Tariq ST Stevens Robert D RD Yoshitoyo Ueno U Asehnoune Karim K

Annals of translational medicine 20200401 7

<h4>Background</h4>Prolonged invasive ventilation is common in patients with severe brain injury. Information on optimal management of extubation and on the use of tracheostomy in these patients is scarce. International guidelines regarding the ventilator liberation and tracheostomy are currently lacking.<h4>Methods</h4>The aim of 'Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes' (ENIO) study is to describe current management of weaning from invasive ve ...[more]

PMID: 32395547

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Project description:BackgroundIn patients with acute brain injury (ABI) and refractory intracranial hypertension, the so-called 'tier three therapies' (TTT) (hypothermia, metabolic suppression with barbiturates, and decompressive craniectomy) may be used.ObjectiveWe aimed to describe the incidence of use of TTT, and to assess their effect on outcome.DesignA secondary analysis of the ENIO observational study.SettingSeventy-three intensive care units (ICUs) in 18 countries worldwide between June 2018 and November 2020.PatientsOne thousand five hundred and twelve adult patients admitted to an intensive care unit (ICU) with ABI were included and categorised according to use or not of one or more TTT.ResultsThree hundred and ninety-six patients (26.2%) received at least one TTT during the ICU stay. Five patients (0.3%) received all three TTT. TTT patients were younger (P < 0.0001), less likely to have a preinjury history of hypertension (P = 0.0008), and less frequently anisocoric within 24 h from ICU admission (P < 0.0001) than those with no tier three therapy. TTT were used less frequently in high-income countries than in upper income and lower middle-income countries (no TTT in 78% of patients in high-income countries, in 60.6% of patients in upper middle-income countries, and in 56.6% of patients in lower middle-income countries; P < 0.0001). TTT were more frequent in patients with traumatic brain injury (TBI) compared with other types of ABI and in patients with invasive intracranial pressure (ICP) monitoring (P < 0.0001). TTT use was associated with a higher incidence of ventilator-associated pneumonia (P < 0.0001), need for tracheostomy (P = 0.0194), and prolonged ICU length of stay (LOS; P < 0.0001) but not with increased ICU or hospital mortality (P = 0.999).ConclusionPatients with ABI are frequently managed using at least one TTT. Their use varies according to a country's economic resources, the type of ABI, and ICP monitoring and is associated with a higher risk of complications but not with ICU or hospital mortality.

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Dataset Information

Extubation strategies in neuro-intensive care unit patients and associations with outcomes: the ENIO multicentre international observational study.

Background

Methods

Discussion

Trial registration

Publications

Extubation strategies in neuro-intensive care unit patients and associations with outcomes: the ENIO multicentre international observational study.

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