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

Subjects
Mechanical power, Mechanical ventilation, Traumatic brain injury, Acute respiratory distress syndrome, Acute ischemic stroke, Acute brain injury, Intracranial hemorrhage, Subarachnoid hemorrhage
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) ≥ 24h. 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 51.2years [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 11.9J/min [IQR 9.2-15.1], 13J/min [IQR 10-17], and 14J/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 11.9J/min, aRR at 17J/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 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation.

Published
2023

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