TY - JOUR
T1 - Weaning Outcomes in Patients with Brain Injury
AU - Tejerina, Eva E.
AU - Robba, Chiara
AU - del Campo-Albendea, Laura
AU - Pelosi, Paolo
AU - Muriel, Alfonso
AU - Peñuelas, Oscar
AU - Frutos-Vivar, Fernando
AU - Raymondos, Konstantinos
AU - Du, Bin
AU - Thille, Arnaud W.
AU - Ríos, Fernando
AU - González, Marco
AU - del-Sorbo, Lorenzo
AU - Marín, Maria del Carmen
AU - Valle Pinheiro, Bruno
AU - Soares, Marco Antonio
AU - Nin, Nicolas
AU - Maggiore, Salvatore M.
AU - Bersten, Andrew
AU - Amin, Pravin
AU - Cakar, Nahit
AU - Young Suh, Gee
AU - Abroug, Fekri
AU - Jibaja, Manuel
AU - Matamis, Dimitros
AU - Ali Zeggwagh, Amine
AU - Sutherasan, Yuda
AU - Anzueto, Antonio
AU - Esteban, Andrés
N1 - Publisher Copyright:
© 2022, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
PY - 2022/12
Y1 - 2022/12
N2 - Background: Despite the need for specific weaning strategies in neurological patients, evidence is generally insufficient or lacking. We aimed to describe the evolution over time of weaning and extubation practices in patients with acute brain injury compared with patients who are mechanically ventilated (MV) due to other reasons. Methods: We performed a secondary analysis of three prospective, observational, multicenter international studies conducted in 2004, 2010, and 2016 in adults who had need of invasive MV for more than 12 h. We collected data on baseline characteristics, variables related to management ventilator settings, and complications while patients were ventilated or until day 28. Results: Among the 20,929 patients enrolled, we included 12,618 (60%) who started the weaning from MV, of whom 1722 (14%) were patients with acute brain injury. In the acutely brain-injured cohort, 538 patients (31%) did not undergo planned extubation, defined as the need for a tracheostomy without an attempt of extubation, accidental extubation, and death. Among the 1184 planned extubated patients with acute brain injury, 202 required reintubation (17%). Patients with acute brain injury had a higher odds for unplanned extubation (odds ratio [OR] 1.35, confidence interval for 95% [CI 95%] 1.19–1.54; p < 0.001), a higher odds of failure after the first attempt of weaning (spontaneous breathing trial or gradual reduction of ventilatory support; OR 1.14 [CI 95% 1.01–1.30; p = 0.03]), and a higher odds for reintubation (OR 1.41 [CI 95% 1.20–1.66; p < 0.001]) than patients without brain injury. Patients with hemorrhagic stroke had the highest odds for unplanned extubation (OR 1.47 [CI 95% 1.22–1.77; p < 0.001]), of failed extubation after the first attempt of weaning (OR 1.28 [CI 95% 1.06–1.55; p = 0.009]), and for reintubation (OR 1.49 [CI 95% 1.17–1.88; p < 0.001]). In relation to weaning evolution over time in patients with acute brain injury, the risk for unplanned extubation showed a downward trend; the risk for reintubation was not associated to time; and there was a significant increase in the percentage of patients who underwent extubation after the first attempt of weaning from MV. Conclusions: Patients with acute brain injury, compared with patients without brain injury, present higher odds of undergoing unplanned extubated after weaning was started, lower odds of being extubated after the first attempt, and a higher risk of reintubation.
AB - Background: Despite the need for specific weaning strategies in neurological patients, evidence is generally insufficient or lacking. We aimed to describe the evolution over time of weaning and extubation practices in patients with acute brain injury compared with patients who are mechanically ventilated (MV) due to other reasons. Methods: We performed a secondary analysis of three prospective, observational, multicenter international studies conducted in 2004, 2010, and 2016 in adults who had need of invasive MV for more than 12 h. We collected data on baseline characteristics, variables related to management ventilator settings, and complications while patients were ventilated or until day 28. Results: Among the 20,929 patients enrolled, we included 12,618 (60%) who started the weaning from MV, of whom 1722 (14%) were patients with acute brain injury. In the acutely brain-injured cohort, 538 patients (31%) did not undergo planned extubation, defined as the need for a tracheostomy without an attempt of extubation, accidental extubation, and death. Among the 1184 planned extubated patients with acute brain injury, 202 required reintubation (17%). Patients with acute brain injury had a higher odds for unplanned extubation (odds ratio [OR] 1.35, confidence interval for 95% [CI 95%] 1.19–1.54; p < 0.001), a higher odds of failure after the first attempt of weaning (spontaneous breathing trial or gradual reduction of ventilatory support; OR 1.14 [CI 95% 1.01–1.30; p = 0.03]), and a higher odds for reintubation (OR 1.41 [CI 95% 1.20–1.66; p < 0.001]) than patients without brain injury. Patients with hemorrhagic stroke had the highest odds for unplanned extubation (OR 1.47 [CI 95% 1.22–1.77; p < 0.001]), of failed extubation after the first attempt of weaning (OR 1.28 [CI 95% 1.06–1.55; p = 0.009]), and for reintubation (OR 1.49 [CI 95% 1.17–1.88; p < 0.001]). In relation to weaning evolution over time in patients with acute brain injury, the risk for unplanned extubation showed a downward trend; the risk for reintubation was not associated to time; and there was a significant increase in the percentage of patients who underwent extubation after the first attempt of weaning from MV. Conclusions: Patients with acute brain injury, compared with patients without brain injury, present higher odds of undergoing unplanned extubated after weaning was started, lower odds of being extubated after the first attempt, and a higher risk of reintubation.
KW - Brain injury
KW - Extubation
KW - Mechanical ventilation
KW - Outcome
KW - Weaning
UR - http://www.scopus.com/inward/record.url?scp=85137012505&partnerID=8YFLogxK
U2 - 10.1007/s12028-022-01584-2
DO - 10.1007/s12028-022-01584-2
M3 - Artículo en revista científica indexada
AN - SCOPUS:85137012505
SN - 1541-6933
VL - 37
SP - 649
EP - 659
JO - Neurocritical Care
JF - Neurocritical Care
IS - 3
ER -