Department of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, 44000, Nantes, France.
UMR 1246 SPHERE "MethodS in Patients-Centered Outcomes and HEalth Research", University of Nantes, University of Tours, INSERM, IRS2 22 Boulevard Benoni Goulin, 44200, Nantes, France.
Intensive Care Med. 2022 Nov;48(11):1539-1550. doi: 10.1007/s00134-022-06825-8. Epub 2022 Aug 29.
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.
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.
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) [0.71-0.87] and 0.71 CI [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).
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.
神经危重症患者需要接受长时间的有创机械通气（IMV），但在这个高危人群中，关于有创机械通气撤离策略的具体信息很少。
ENIO（NCT03400904）是一项国际性、前瞻性观察性研究，于 2018 年至 2020 年在 18 个国家的 73 个重症监护病房（ICU）进行。纳入格拉斯哥昏迷评分（GCS）≤12、接受 IMV≥24 小时、行气管插管尝试或气管切开术的神经危重症患者。主要终点为第 5 天拔管失败。创建了一个拔管成功预测评分，将 2/3 的患者随机分配到训练队列，1/3 患者分配到验证队列。次要终点为 IMV 持续时间和 ICU 死亡率。
共纳入 1512 例患者。在 1193 例（78.9%）接受气管插管尝试的患者中，记录到 231 例（19.4%）拔管失败。成功拔管预测评分保留了 20 个独立预测因素。在训练队列中，曲线下面积（AUC）为 0.79（95%置信区间[0.71-0.87]），验证队列中 AUC 为 0.71（95%置信区间[0.61-0.81]）。拔管失败的患者 IMV 持续时间更长（14[7-21]天 vs 6[3-11]天），ICU 死亡率更高（8.7% vs 2.4%）。319 例（21.1%）患者未经气管插管尝试而行气管切开术。直接行气管切开术的患者与有气管插管尝试的患者（成功和失败）相比，IMV 持续时间更长，ICU 死亡率更高。
在神经危重症患者中，拔管失败率较高，与不良结局相关。评分可以在多种情况下预测拔管成功。然而，在另一个前瞻性独立队列中验证我们的发现将是必要的。
