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Background: Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. Methods: We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. Results: We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. Conclusions: ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.

Rationale: Whether extubation immediately after a successful spontaneous breathing trial is associated with clinical benefits in adult patients with acute brain injury is unknown., Objectives: We sought to estimate the association between a prompt extubation attempt and ventilator-free days among adult patients with acute brain injury., Methods: We performed an emulation of a previously designed randomized controlled trial using data from the Toronto Intensive Care Observational Registry in 8 intensive care units in Toronto, Ontario. We included mechanically ventilated adult patients with acute brain injury who had a first successful spontaneous breathing trial. Our main exposure was prompt extubation (i.e., on the same calendar day following the first successful spontaneous breathing trial). The primary outcome was ventilator-free days up to 28 days. We used inverse probability of treatment weighting to adjust for confounding and reported treatment effects using incidence rate ratios (IRR) and 95% confidence intervals (CI)., Measurements and Main Results: 1,406 patients between April 2014 through March 2023 met inclusion criteria. The main reasons for admission were traumatic brain injury (40%), stroke (ischemic or hemorrhagic; 20%), seizures (11%), and subarachnoid hemorrhage (9%). Over half (57%) of patients underwent prompt extubation following their first successful spontaneous breathing trial. Prompt extubation was associated with more ventilator-free days (IRR: 1.24; 95% CI: 1.19 - 1.29) when compared to no prompt extubation., Conclusions: Prompt extubation following a first successful spontaneous breathing trial was associated with more ventilator-free days (up to 28 days) among adults with acute brain injury receiving invasive mechanical ventilation.