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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

Author

Taran, S, Perrot, B, Angriman, F, Cinotti, R, Abback, P, Codorniu, A, Citerio, G, Ludovica Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Giuseppina Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Fathi Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, Van Vliet, P, Marcel Gerretsen, B, Xochitl Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Daniel Cornet, A, Reyes Inurrigarro, S, Cirino Lara Dominguez, R, Mercedes Bellini, M, Milagros Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Carlos Miranda-Ackerman, R, Jose Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Basheer Yahya, H, Khaled, A, Ghula, M, Neville Andrea, C, Maria Daniela, P, Deana, C, Vetrugno, L, Rivera Chavez, M, Mendoza Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, Van Der Jagt, M, Van Steenkiste, J, Ahmed, H, Edward Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, Paul Van Meenen, D, Adrian Gasca, G, Arellano, A, Galicia-Espinosa, F, Carlos Garcia-Ramos, J, Yadav, G, Kumar Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Tariq Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Bedanta Mishra, S, Samal, S, Cesar Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Agustin Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Atef Azab, M, Catherine Digitale, J, Fong, N, Campos Cerda, R, De La Torre Peredo, N, David Stevens, R, Taran S., Perrot B., Angriman F., Cinotti R., Abback P. -S., Codorniu A., Citerio G., Ludovica Sala V., Astuto M., Tringali E., Alampi D., Rocco M., Giuseppina Maugeri J., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Fathi Al-Gharyani M., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., Van Vliet P., Marcel Gerretsen B., Xochitl Ortiz-Macias I., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Daniel Cornet A., Reyes Inurrigarro S., Cirino Lara Dominguez R., Mercedes Bellini M., Milagros Gomez Haedo M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Carlos Miranda-Ackerman R., Jose Barbosa-Camacho F., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Basheer Yahya H., Khaled A., Ghula M., Neville Andrea C., Maria Daniela P., Deana C., Vetrugno L., Rivera Chavez M. J., Mendoza Trujillo R., Legros V., Brochet B., Huet O., Geslain M., Van Der Jagt M., Van Steenkiste J., Ahmed H., Edward Coombs A., Welbourne J., Velarde Pineda A. A., Nubert Castillo V. H., Azab M. A., Azzam A. Y., Paul Van Meenen D. M., Adrian Gasca G., Arellano A., Galicia-Espinosa F., Carlos Garcia-Ramos J., Yadav G., Kumar Jha A., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Tariq Reza S., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Bedanta Mishra S., Samal S., Cesar Mijangos J., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Agustin Godoy D., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Atef Azab M., Catherine Digitale J., Fong N., Campos Cerda R., De La Torre Peredo N., David Stevens R., Taran, S, Perrot, B, Angriman, F, Cinotti, R, Abback, P, Codorniu, A, Citerio, G, Ludovica Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Giuseppina Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Fathi Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, Van Vliet, P, Marcel Gerretsen, B, Xochitl Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Daniel Cornet, A, Reyes Inurrigarro, S, Cirino Lara Dominguez, R, Mercedes Bellini, M, Milagros Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Carlos Miranda-Ackerman, R, Jose Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Basheer Yahya, H, Khaled, A, Ghula, M, Neville Andrea, C, Maria Daniela, P, Deana, C, Vetrugno, L, Rivera Chavez, M, Mendoza Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, Van Der Jagt, M, Van Steenkiste, J, Ahmed, H, Edward Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, Paul Van Meenen, D, Adrian Gasca, G, Arellano, A, Galicia-Espinosa, F, Carlos Garcia-Ramos, J, Yadav, G, Kumar Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Tariq Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Bedanta Mishra, S, Samal, S, Cesar Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Agustin Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Atef Azab, M, Catherine Digitale, J, Fong, N, Campos Cerda, R, De La Torre Peredo, N, David Stevens, R, Taran S., Perrot B., Angriman F., Cinotti R., Abback P. -S., Codorniu A., Citerio G., Ludovica Sala V., Astuto M., Tringali E., Alampi D., Rocco M., Giuseppina Maugeri J., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Fathi Al-Gharyani M., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., Van Vliet P., Marcel Gerretsen B., Xochitl Ortiz-Macias I., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Daniel Cornet A., Reyes Inurrigarro S., Cirino Lara Dominguez R., Mercedes Bellini M., Milagros Gomez Haedo M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Carlos Miranda-Ackerman R., Jose Barbosa-Camacho F., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Basheer Yahya H., Khaled A., Ghula M., Neville Andrea C., Maria Daniela P., Deana C., Vetrugno L., Rivera Chavez M. J., Mendoza Trujillo R., Legros V., Brochet B., Huet O., Geslain M., Van Der Jagt M., Van Steenkiste J., Ahmed H., Edward Coombs A., Welbourne J., Velarde Pineda A. A., Nubert Castillo V. H., Azab M. A., Azzam A. Y., Paul Van Meenen D. M., Adrian Gasca G., Arellano A., Galicia-Espinosa F., Carlos Garcia-Ramos J., Yadav G., Kumar Jha A., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Tariq Reza S., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Bedanta Mishra S., Samal S., Cesar Mijangos J., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Agustin Godoy D., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Atef Azab M., Catherine Digitale J., Fong N., Campos Cerda R., De La Torre Peredo N., and David Stevens R.

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 i

Published
2024

2. Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study

Author

Robba, C, Battaglini, D, Abbas, A, Sarrió, E, Cinotti, R, Asehnoune, K, Taccone, F, Rocco, P, Schultz, M, Citerio, G, Stevens, R, Badenes, R, Abback, P, Codorniu, A, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garçon, P, Zarka, J, Vermeijden, W, Cornet, A, Gard, S, Domínguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronial, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Companion, B, Pérez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghulam, M, Andrea, C, Daniela, P, Deana, C, Vertigo, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, García-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haënggi, M, Gurjar, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Mccredie, V, Suei, E, Haenggi, M, Samir, J, Robba, Chiara, Battaglini, Denise, Abbas, Abbas, Sarrió, Ezequiel, Cinotti, Raphael, Asehnoune, Karim, Taccone, Fabio S., Rocco, Patricia R., Schultz, Marcus J., Citerio, Giuseppe, Stevens, Robert David, Badenes, Rafael, Abback, Paër-Sélim, Codorniu, Anaïs, Sala, Vittoria Ludovica, Astuto, Marinella, Tringali, Eleonora, Alampi, Daniela, Rocco, Monica, Maugeri, Jessica Giuseppina, Bellissima, Agrippino, Filippini, Matteo, Lazzeri, Nicoletta, Cortegiani, Andrea, Ippolito, Mariachiara, Biston, Patrick, Al-Gharyani, Mohamed Fathi, Chabanne, Russell, Astier, Léo, Soyer, Benjamin, Gaugain, Samuel, Zimmerli, Alice, Pietsch, Urs, Filipovic, Miodrag, Brandi, Giovanna, Bicciato, Giulio, Serrano, Ainhoa, Monleon, Berta, van Vliet, Peter, Gerretsen, Benjamin Marcel, Ortiz-Macias, Iris Xochitl, Oto, Jun, Enomoto, Noriya, Matsuda, Tomomichi, Masui, Nobutaka, Garçon, Pierre, Zarka, Jonathan, Vermeijden, Wytze J., Cornet, Alexander Daniel, Gard, Sergio Reyes Infra, Domínguez, Rafael Cirino Lara, Bellini, Maria Mercedes, Haedo, Maria Milagros Gomez, Lamot, Laura, Orquera, Jose, Biais, Matthieu, Georges, Delphine, Baronial, Arvind, Miranda-Ackerman, Roberto Carlos, Barbosa-Camacho, Francisco José, Porter, John, Lopez-Morales, Miguel, Geeraerts, Thomas, Companion, Baptiste, Pérez-Torres, David, Prol-Silva, Estefanía, Yahya, Hana Basheer, Khaled, Ala, Ghulam, Mohamed, Andrea, Cracchiolo Neville, Daniela, Palma Maria, Deana, Cristian, Vertigo, Luigi, Chavez, Manuel J. Rivera, Trujillo, Rocio Mendoza, Legros, Vincent, Brochet, Benjamin, Huet, Olivier, Geslain, Marie, van der Jagt, Mathieu, van Steenkiste, Job, Ahmed, Hazem, Coombs, Alexander Edward, Welbourne, Jessie, Pineda, Ana Alicia Velarde, Castillo, Víctor Hugo Nubert, Azab, Mohammed A., Azzam, Ahmed Y., van Meenen, David Michael Paul, Gasca, Gilberto Adrian, Arellano, Alfredo, Galicia-Espinosa, Forttino, García-Ramos, José Carlos, Yadav, Ghanshyam, Jha, Amarendra Kumar, Robert-Edan, Vincent, Rodie-Talbere, Pierre-Andre, Jain, Gaurav, Panda, Sagarika, Agarwal, Sonika, Deewan, Yashbir, Reza, Syed Tariq, Hossain, Md. Mozaffer, Papadas, Christos, Chantziara, Vasiliki, Sklavou, Chrysanthi, Hourmant, Yannick, Grillot, Nicolas, Pirracchio, Romain, Akkari, Abdelraouf, Abdelaty, Mohamed, Hashim, Ahmed, Launey, Yoann, Masseret, Elodie, Lasocki, Sigismond, Gergaud, Soizic, Mouclier, Nicolas, Saxena, Sulekha, Agrawal, Avinash, Mishra, Shakti Bedanta, Samal, Samir, Mijangos, Julio Cesar, Haënggi, Mattias, Gurjar, Mohan, Kaye, Callum, Godoy, Daniela Agustin, Alvarez, Pablo, Ioakeimidou, Aikaterini, Ueno, Yoshitoyo, Elbuzidi, Abdurrahmaan Ali Suei, Piagnerelli, Michaël, Elhadi, Muhammed, Azab, Mohammed Atef, Digitale, Jean Catherine, Fong, Nicholas, Cerda, Ricardo Campos, de la Torre Peredo, Norma, McCredie, Victoria, Suei, Elbuzidi Abdurrahmaan Ali, Haenggi, Matthias, Samir, Jaber, Robba, C, Battaglini, D, Abbas, A, Sarrió, E, Cinotti, R, Asehnoune, K, Taccone, F, Rocco, P, Schultz, M, Citerio, G, Stevens, R, Badenes, R, Abback, P, Codorniu, A, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garçon, P, Zarka, J, Vermeijden, W, Cornet, A, Gard, S, Domínguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronial, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Companion, B, Pérez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghulam, M, Andrea, C, Daniela, P, Deana, C, Vertigo, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, García-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haënggi, M, Gurjar, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Mccredie, V, Suei, E, Haenggi, M, Samir, J, Robba, Chiara, Battaglini, Denise, Abbas, Abbas, Sarrió, Ezequiel, Cinotti, Raphael, Asehnoune, Karim, Taccone, Fabio S., Rocco, Patricia R., Schultz, Marcus J., Citerio, Giuseppe, Stevens, Robert David, Badenes, Rafael, Abback, Paër-Sélim, Codorniu, Anaïs, Sala, Vittoria Ludovica, Astuto, Marinella, Tringali, Eleonora, Alampi, Daniela, Rocco, Monica, Maugeri, Jessica Giuseppina, Bellissima, Agrippino, Filippini, Matteo, Lazzeri, Nicoletta, Cortegiani, Andrea, Ippolito, Mariachiara, Biston, Patrick, Al-Gharyani, Mohamed Fathi, Chabanne, Russell, Astier, Léo, Soyer, Benjamin, Gaugain, Samuel, Zimmerli, Alice, Pietsch, Urs, Filipovic, Miodrag, Brandi, Giovanna, Bicciato, Giulio, Serrano, Ainhoa, Monleon, Berta, van Vliet, Peter, Gerretsen, Benjamin Marcel, Ortiz-Macias, Iris Xochitl, Oto, Jun, Enomoto, Noriya, Matsuda, Tomomichi, Masui, Nobutaka, Garçon, Pierre, Zarka, Jonathan, Vermeijden, Wytze J., Cornet, Alexander Daniel, Gard, Sergio Reyes Infra, Domínguez, Rafael Cirino Lara, Bellini, Maria Mercedes, Haedo, Maria Milagros Gomez, Lamot, Laura, Orquera, Jose, Biais, Matthieu, Georges, Delphine, Baronial, Arvind, Miranda-Ackerman, Roberto Carlos, Barbosa-Camacho, Francisco José, Porter, John, Lopez-Morales, Miguel, Geeraerts, Thomas, Companion, Baptiste, Pérez-Torres, David, Prol-Silva, Estefanía, Yahya, Hana Basheer, Khaled, Ala, Ghulam, Mohamed, Andrea, Cracchiolo Neville, Daniela, Palma Maria, Deana, Cristian, Vertigo, Luigi, Chavez, Manuel J. Rivera, Trujillo, Rocio Mendoza, Legros, Vincent, Brochet, Benjamin, Huet, Olivier, Geslain, Marie, van der Jagt, Mathieu, van Steenkiste, Job, Ahmed, Hazem, Coombs, Alexander Edward, Welbourne, Jessie, Pineda, Ana Alicia Velarde, Castillo, Víctor Hugo Nubert, Azab, Mohammed A., Azzam, Ahmed Y., van Meenen, David Michael Paul, Gasca, Gilberto Adrian, Arellano, Alfredo, Galicia-Espinosa, Forttino, García-Ramos, José Carlos, Yadav, Ghanshyam, Jha, Amarendra Kumar, Robert-Edan, Vincent, Rodie-Talbere, Pierre-Andre, Jain, Gaurav, Panda, Sagarika, Agarwal, Sonika, Deewan, Yashbir, Reza, Syed Tariq, Hossain, Md. Mozaffer, Papadas, Christos, Chantziara, Vasiliki, Sklavou, Chrysanthi, Hourmant, Yannick, Grillot, Nicolas, Pirracchio, Romain, Akkari, Abdelraouf, Abdelaty, Mohamed, Hashim, Ahmed, Launey, Yoann, Masseret, Elodie, Lasocki, Sigismond, Gergaud, Soizic, Mouclier, Nicolas, Saxena, Sulekha, Agrawal, Avinash, Mishra, Shakti Bedanta, Samal, Samir, Mijangos, Julio Cesar, Haënggi, Mattias, Gurjar, Mohan, Kaye, Callum, Godoy, Daniela Agustin, Alvarez, Pablo, Ioakeimidou, Aikaterini, Ueno, Yoshitoyo, Elbuzidi, Abdurrahmaan Ali Suei, Piagnerelli, Michaël, Elhadi, Muhammed, Azab, Mohammed Atef, Digitale, Jean Catherine, Fong, Nicholas, Cerda, Ricardo Campos, de la Torre Peredo, Norma, McCredie, Victoria, Suei, Elbuzidi Abdurrahmaan Ali, Haenggi, Matthias, and Samir, Jaber

Abstract

Purpose: The use of arterial partial pressure of carbon dioxide (PaCO2) as a target intervention to manage elevated intracranial pressure (ICP) and its effect on clinical outcomes remain unclear. We aimed to describe targets for PaCO2 in acute brain injured (ABI) patients and assess the occurrence of abnormal PaCO2 values during the first week in the intensive care unit (ICU). The secondary aim was to assess the association of PaCO2 with in-hospital mortality. Methods: We carried out a secondary analysis of a multicenter prospective observational study involving adult invasively ventilated patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracranial hemorrhage (ICH), or ischemic stroke (IS). PaCO2 was collected on day 1, 3, and 7 from ICU admission. Normocapnia was defined as PaCO2 > 35 and to 45 mmHg; mild hypocapnia as 32–35 mmHg; severe hypocapnia as 26–31 mmHg, forced hypocapnia as < 26 mmHg, and hypercapnia as > 45 mmHg. Results: 1476 patients (65.9% male, mean age 52 ± 18 years) were included. On ICU admission, 804 (54.5%) patients were normocapnic (incidence 1.37 episodes per person/day during ICU stay), and 125 (8.5%) and 334 (22.6%) were mild or severe hypocapnic (0.52 and 0.25 episodes/day). Forced hypocapnia and hypercapnia were used in 40 (2.7%) and 173 (11.7%) patients. PaCO2 had a U-shape relationship with in-hospital mortality with only severe hypocapnia and hypercapnia being associated with increased probability of in-hospital mortality (omnibus p value = 0.0009). Important differences were observed across different subgroups of ABI patients. Conclusions: Normocapnia and mild hypocapnia are common in ABI patients and do not affect patients' outcome. Extreme derangements of PaCO2 values were significantly associated with increased in-hospital mortality.

Published
2024

3. Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Author

Wahlster, S, Sharma, M, Taran, S, Town, J, Stevens, R, Cinotti, R, Asehoune, K, Pelosi, P, Robba, C, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Wahlster S., Sharma M., Taran S., Town J. A., Stevens R. D., Cinotti R., Asehoune K., Pelosi P., Robba C., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Velarde Pineda A. A., Nubert Castillo V. H., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., de la Torre Peredo N., Wahlster, S, Sharma, M, Taran, S, Town, J, Stevens, R, Cinotti, R, Asehoune, K, Pelosi, P, Robba, C, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Wahlster S., Sharma M., Taran S., Town J. A., Stevens R. D., Cinotti R., Asehoune K., Pelosi P., Robba C., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Velarde Pineda A. A., Nubert Castillo V. H., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., and de la Torre Peredo N.

Abstract

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2–15.1], 13 J/min [IQR 10–17], and 14 J/min [IQR 11–20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14–1.30) and HD3 (1.38, 95% CI 1.23–1.53), reintubation on HD1 (1.64; 95% CI 1.57–1.72), and tracheostomy on HD7 (1

Published
2023

4. Individualized Thresholds of Hypoxemia and Hyperoxemia and their Effect on Outcome in Acute Brain Injured Patients: A Secondary Analysis of the ENIO Study

Author

Robba, C, Battaglini, D, Cinotti, R, Asehnoune, K, Stevens, R, Taccone, F, Badenes, R, Pelosi, P, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Agrippino, B, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez-Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Cracchiolo Neville, A, Palma, M, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Robba C., Battaglini D., Cinotti R., Asehnoune K., Stevens R., Taccone F. S., Badenes R., Pelosi P., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Agrippino B., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez-Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Cracchiolo Neville A., Palma M. D., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Elbuzidi A. A. S., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., de la Torre Peredo N., Robba, C, Battaglini, D, Cinotti, R, Asehnoune, K, Stevens, R, Taccone, F, Badenes, R, Pelosi, P, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Agrippino, B, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez-Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Cracchiolo Neville, A, Palma, M, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Robba C., Battaglini D., Cinotti R., Asehnoune K., Stevens R., Taccone F. S., Badenes R., Pelosi P., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Agrippino B., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez-Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Cracchiolo Neville A., Palma M. D., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Elbuzidi A. A. S., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., and de la Torre Peredo N.

Abstract

Background: In acute brain injury (ABI), the effects of hypoxemia as a potential cause of secondary brain damage and poor outcome are well documented, whereas the impact of hyperoxemia is unclear. The primary aim of this study was to assess the episodes of hypoxemia and hyperoxemia in patients with ABI during the intensive care unit (ICU) stay and to determine their association with in-hospital mortality. The secondary aim was to identify the optimal thresholds of arterial partial pressure of oxygen (PaO2) predicting in-hospital mortality. Methods: We conducted a secondary analysis of a prospective multicenter observational cohort study. Adult patients with ABI (traumatic brain injury, subarachnoid aneurysmal hemorrhage, intracranial hemorrhage, ischemic stroke) with available data on PaO2 during the ICU stay were included. Hypoxemia was defined as PaO2 < 80 mm Hg, normoxemia was defined as PaO2 between 80 and 120 mm Hg, mild/moderate hyperoxemia was defined as PaO2 between 121 and 299 mm Hg, and severe hyperoxemia was defined as PaO2 levels ≥ 300 mm Hg. Results: A total of 1,407 patients were included in this study. The mean age was 52 (±18) years, and 929 (66%) were male. Over the ICU stay, the fractions of patients in the study cohort who had at least one episode of hypoxemia, mild/moderate hyperoxemia, and severe hyperoxemia were 31.3%, 53.0%, and 1.7%, respectively. PaO2 values below 92 mm Hg and above 156 mm Hg were associated with an increased probability of in-hospital mortality. Differences were observed among subgroups of patients with ABI, with consistent effects only seen in patients without traumatic brain injury. Conclusions: In patients with ABI, hypoxemia and mild/moderate hyperoxemia were relatively frequent. Hypoxemia and hyperoxemia during ICU stay may influence in-hospital mortality. However, the small number of oxygen values collected represents a major limitation of the study.

Published
2023

5. Risk factors of extubation failure in neurocritical patients with the most impaired consciousness

Author

de Courson, H, Massart, N, Asehnoune, K, Cinotti, R, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espino-sa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Fong, N, Digitale, J, Stevens, R, Mijangos, J, Haenngi, M, Gurjar, M, Schultz, M, Godoy, D, Alvarez, P, Kaye, C, Ioakeimidou, A, Ueno, Y, Badenes, R, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Cerda, R, Peredo, N, de Courson H., Massart N., Asehnoune K., Cinotti R., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espino-sa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Fong N., Digitale J., Stevens R., Mijangos J. C., Haenngi M., Gurjar M., Schultz M., Godoy D. A., Alvarez P., Kaye C., Ioakeimidou A., Ueno Y., Badenes R., Elbuzidi A. S., Piagnerelli M., Elhadi M., Cerda R., Peredo N., de Courson, H, Massart, N, Asehnoune, K, Cinotti, R, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espino-sa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Fong, N, Digitale, J, Stevens, R, Mijangos, J, Haenngi, M, Gurjar, M, Schultz, M, Godoy, D, Alvarez, P, Kaye, C, Ioakeimidou, A, Ueno, Y, Badenes, R, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Cerda, R, Peredo, N, de Courson H., Massart N., Asehnoune K., Cinotti R., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espino-sa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Fong N., Digitale J., Stevens R., Mijangos J. C., Haenngi M., Gurjar M., Schultz M., Godoy D. A., Alvarez P., Kaye C., Ioakeimidou A., Ueno Y., Badenes R., Elbuzidi A. S., Piagnerelli M., Elhadi M., Cerda R., and Peredo N.

Published
2023

6. Extubation in neurocritical care patients: the ENIO international prospective study

Author

Cinotti, R, Mijangos, J, Pelosi, P, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Reza, S, Azab, M, Mccredie, V, Stevens, R, Digitale, J, Fong, N, Asehnoune, K, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Cinotti R., Mijangos J. C., Pelosi P., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Reza S. T., Azab M. A., McCredie V., Stevens R. D., Digitale J. C., Fong N., Asehnoune K., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Cinotti, R, Mijangos, J, Pelosi, P, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Reza, S, Azab, M, Mccredie, V, Stevens, R, Digitale, J, Fong, N, Asehnoune, K, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Cinotti R., Mijangos J. C., Pelosi P., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Reza S. T., Azab M. A., McCredie V., Stevens R. D., Digitale J. C., Fong N., Asehnoune K., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., and Samal S.

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.

Published
2022

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