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

Author

Cinotti, Raphaël, Mijangos, Julio Cesar, Pelosi, Paolo, Haenggi, Matthias, Gurjar, Mohan, Schultz, Marcus J., and Kaye, Callum

Subjects
Medical research, Medicine, Experimental, Mortality -- France -- United Kingdom -- Netherlands, Evidence-based medicine, Tracheostomy, Health care industry
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) [less than or equal to] 12, receiving IMV [greater than or equal to] 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 (CI.sub.95) [0.71-0.87] and 0.71 CI.sub.95 [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., Author(s): Raphaël Cinotti [sup.1] [sup.2], Julio Cesar Mijangos [sup.3] [sup.4], Paolo Pelosi [sup.5] [sup.6], Matthias Haenggi [sup.7], Mohan Gurjar [sup.8], Marcus J. Schultz [sup.9] [sup.10] [sup.11], Callum Kaye [sup.12], Daniel [...]

Published
2022
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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. Association of Non-Invasive Respiratory Support with Extubation Outcomes in Brain-Injured Patients Receiving Mechanical Ventilation: A Secondary Analysis of ENIO

Author

Taran, Shaurya, primary, Diaz-Cruz, Camilo, additional, Perrot, Bastien, additional, Alvarez, Pablo, additional, Godoy, Daniel Agustin, additional, Gurjar, Mohan, additional, Haenggi, Matthias, additional, Mijangos, Julio Cesar, additional, Pelosi, Paolo, additional, Robba, Chiara, additional, Schultz, Marcus J., additional, Ueno, Yoshitoyo, additional, Asehnoune, Karim, additional, Cho, Sung Min, additional, Yarnell, Christopher J, additional, Cinotti, Raphael, additional, and Stevens, Robert D, additional

Published
2023
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4. Association of Noninvasive Respiratory Support with Extubation Outcomes in Brain-injured Patients Receiving Mechanical Ventilation: A Secondary Analysis of the ENIO Prospective Observational Study.

Author

Taran S, Diaz-Cruz C, Perrot B, Alvarez P, Godoy DA, Gurjar M, Haenggi M, Mijangos JC, Pelosi P, Robba C, Schultz MJ, Ueno Y, Asehnoune K, Cho SM, Yarnell CJ, Cinotti R, and Stevens RD

Subjects
Humans, Respiration, Artificial, Airway Extubation, Bayes Theorem, Prospective Studies, Oxygen Inhalation Therapy methods, Cannula, Brain, Noninvasive Ventilation, Brain Injuries complications, Brain Injuries therapy, Respiratory Insufficiency therapy
Abstract

Rationale: Noninvasive respiratory support using a high-flow nasal cannula (HFNC) or noninvasive positive pressure ventilation (NIPPV) can decrease the risk of reintubation in patients being liberated from mechanical ventilation, but effects in patients with acute brain injury (ABI) are unknown. Objectives: To evaluate the association between postextubation noninvasive respiratory support and reintubation in patients with ABI being liberated from mechanical ventilation. Methods: This was a secondary analysis of a prospective, observational study of mechanically ventilated patients with ABI (clinicaltrials.gov identifier NCT03400904). The primary endpoint was reintubation during ICU admission. We used mixed-effects logistic regression models with patient-level covariates and random intercepts for hospital and country to evaluate the association between prophylactic (i.e., planned) HFNC or NIPPV and reintubation. Measurements and Main Results: 1,115 patients were included from 62 hospitals and 19 countries, of whom 267 received HFNC or NIPPV following extubation (23.9%). Compared with conventional oxygen therapy, neither prophylactic HFNC nor NIPPV was associated with decreased odds of reintubation (respectively, odds ratios of 0.97 [95% confidence interval, 0.54-1.73] and 0.63 [0.30-1.32]). Findings remained consistent in sensitivity analyses accounting for alternate adjustment procedures, missing data, shorter time frames of the primary endpoint, and competing risks precluding reintubation. In a Bayesian analysis using skeptical and data-driven priors, the probabilities of reduced reintubation ranged from 17% to 34% for HFNC and from 46% to 74% for NIPPV. Conclusions: In a large cohort of brain-injured patients undergoing liberation from mechanical ventilation, prophylactic use of HFNC and NIPPV were not associated with reintubation. Prospective trials are needed to confirm treatment effects in this population. Primary study registered with www.clinicaltrials.gov (NCT03400904).

Published
2023
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