Weaning Outcomes in Patients with Brain Injury
Issued Date
2022-12-01
Resource Type
ISSN
15416933
eISSN
15560961
Scopus ID
2-s2.0-85137012505
Pubmed ID
36050534
Journal Title
Neurocritical Care
Volume
37
Issue
3
Start Page
649
End Page
659
Rights Holder(s)
SCOPUS
Bibliographic Citation
Neurocritical Care Vol.37 No.3 (2022) , 649-659
Suggested Citation
Tejerina E.E., Robba C., del Campo-Albendea L., Pelosi P., Muriel A., Peñuelas O., Frutos-Vivar F., Raymondos K., Du B., Thille A.W., Ríos F., González M., del-Sorbo L., Marín M.d.C., Valle Pinheiro B., Soares M.A., Nin N., Maggiore S.M., Bersten A., Amin P., Cakar N., Young Suh G., Abroug F., Jibaja M., Matamis D., Ali Zeggwagh A., Sutherasan Y., Anzueto A., Esteban A. Weaning Outcomes in Patients with Brain Injury. Neurocritical Care Vol.37 No.3 (2022) , 649-659. 659. doi:10.1007/s12028-022-01584-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85269
Title
Weaning Outcomes in Patients with Brain Injury
Author(s)
Tejerina E.E.
Robba C.
del Campo-Albendea L.
Pelosi P.
Muriel A.
Peñuelas O.
Frutos-Vivar F.
Raymondos K.
Du B.
Thille A.W.
Ríos F.
González M.
del-Sorbo L.
Marín M.d.C.
Valle Pinheiro B.
Soares M.A.
Nin N.
Maggiore S.M.
Bersten A.
Amin P.
Cakar N.
Young Suh G.
Abroug F.
Jibaja M.
Matamis D.
Ali Zeggwagh A.
Sutherasan Y.
Anzueto A.
Esteban A.
Robba C.
del Campo-Albendea L.
Pelosi P.
Muriel A.
Peñuelas O.
Frutos-Vivar F.
Raymondos K.
Du B.
Thille A.W.
Ríos F.
González M.
del-Sorbo L.
Marín M.d.C.
Valle Pinheiro B.
Soares M.A.
Nin N.
Maggiore S.M.
Bersten A.
Amin P.
Cakar N.
Young Suh G.
Abroug F.
Jibaja M.
Matamis D.
Ali Zeggwagh A.
Sutherasan Y.
Anzueto A.
Esteban A.
Author's Affiliation
IRCCS San Martino Polyclinic Hospital
South Texas Veterans Health Care System
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Hospital Regional 1° de Octubre ISSSTE
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública
CHU Fattouma-Bourguiba
Universidad Pontificia Bolivariana
Università degli Studi di Genova
Hannover Medical School
Hospital Universitario Ramón y Cajal
Centre Hospitalier Universitaire de Poitiers
Samsung Medical Center, Sungkyunkwan university
Flinders University
Mohammed V University in Rabat
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Papageorgiou General Hospital
İstanbul Tıp Fakültesi
Bombay Hospital and Medical Research Centre
Peking Union Medical College Hospital
Hospital Nacional Professor Dr. Alejandro Posadas
University of G. d'Annunzio Chieti and Pescara
Hospital Universitario de Getafe
Universidade Federal de Juiz de Fora
Hospital Universitario de Montevideo
Hospital de Especialidades Eugenio Espejo
Interdepartmental Division of Critical Care Medicine
Hospital Universitario Sao Jose
South Texas Veterans Health Care System
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Hospital Regional 1° de Octubre ISSSTE
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública
CHU Fattouma-Bourguiba
Universidad Pontificia Bolivariana
Università degli Studi di Genova
Hannover Medical School
Hospital Universitario Ramón y Cajal
Centre Hospitalier Universitaire de Poitiers
Samsung Medical Center, Sungkyunkwan university
Flinders University
Mohammed V University in Rabat
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Papageorgiou General Hospital
İstanbul Tıp Fakültesi
Bombay Hospital and Medical Research Centre
Peking Union Medical College Hospital
Hospital Nacional Professor Dr. Alejandro Posadas
University of G. d'Annunzio Chieti and Pescara
Hospital Universitario de Getafe
Universidade Federal de Juiz de Fora
Hospital Universitario de Montevideo
Hospital de Especialidades Eugenio Espejo
Interdepartmental Division of Critical Care Medicine
Hospital Universitario Sao Jose
Other Contributor(s)
Abstract
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.