Association of Noninvasive Respiratory Support with Extubation Outcomes in Brain-injured Patients Receiving Mechanical Ventilation: A Secondary Analysis of the ENIO Prospective Observational Study
Issued Date
2023-08-01
Resource Type
eISSN
15354970
Scopus ID
2-s2.0-85166395356
Pubmed ID
37192445
Journal Title
American journal of respiratory and critical care medicine
Volume
208
Issue
3
Start Page
270
End Page
279
Rights Holder(s)
SCOPUS
Bibliographic Citation
American journal of respiratory and critical care medicine Vol.208 No.3 (2023) , 270-279
Suggested Citation
Taran S., Diaz-Cruz C., Perrot B., Alvarez P., Godoy D.A., Gurjar M., Haenggi M., Mijangos J.C., Pelosi P., Robba C., Schultz M.J., Ueno Y., Asehnoune K., Cho S.M., Yarnell C.J., Cinotti R., Stevens R.D. Association of Noninvasive Respiratory Support with Extubation Outcomes in Brain-injured Patients Receiving Mechanical Ventilation: A Secondary Analysis of the ENIO Prospective Observational Study. American journal of respiratory and critical care medicine Vol.208 No.3 (2023) , 270-279. 279. doi:10.1164/rccm.202212-2249OC Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/88289
Title
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's Affiliation
Faculty of Tropical Medicine, Mahidol University
IRCCS San Martino Polyclinic Hospital
Sanatorio Pasteur, Argentina
Tokushima University Hospital
Hospital Maciel Montevideo
Nantes Université
Hôtel Dieu CHU de Nantes
Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow
University of Toronto
University Hospital Bern
Universidad de Guadalajara
Nuffield Department of Medicine
Johns Hopkins University
Harvard Medical School
Amsterdam UMC - University of Amsterdam
Johns Hopkins School of Medicine
School of Medicine
Università di Genova
IRCCS San Martino Polyclinic Hospital
Sanatorio Pasteur, Argentina
Tokushima University Hospital
Hospital Maciel Montevideo
Nantes Université
Hôtel Dieu CHU de Nantes
Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow
University of Toronto
University Hospital Bern
Universidad de Guadalajara
Nuffield Department of Medicine
Johns Hopkins University
Harvard Medical School
Amsterdam UMC - University of Amsterdam
Johns Hopkins School of Medicine
School of Medicine
Università di Genova
Other Contributor(s)
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).