Extubation Success Prediction in a Multicentric Cohort of Patients with Severe Brain Injury

• Published in: Anesthesiology (Philadelphia) Vol. 127; no. 2; pp. 338 - 346
• Main Authors: Asehnoune, Karim, Seguin, Philippe, Lasocki, Sigismond, Roquilly, Antoine, Delater, Adrien, Gros, Antoine, Denou, Florian, Mahé, Pierre-Joachim, Nesseler, Nicolas, Demeure-dit-Latte, Dominique, Launey, Yoann, Lakhal, Karim, Rozec, Bertrand, Mallédant, Yannick, Sébille, Véronique, Jaber, Samir, Le Thuaut, Aurélie, Feuillet, Fanny, Cinotti, Raphaël, Blanloeil, Yvonnick
• Format: Journal Article
• Language: English
• Published: United States Copyright by , the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc 01-08-2017; Lippincott, Williams & Wilkins
• Subjects: Adult; Airway Extubation - statistics & numerical data; Brain Injuries - physiopathology; Cohort Studies; Critical Care - methods; Female; Humans; Intensive Care Units; Length of Stay - statistics & numerical data; Life Sciences; Male; Middle Aged; Prospective Studies; Risk Factors; Length of Stay; Intensive Care Units; Prospective Studies; Risk Factors; Middle Aged; Humans; Male; Brain Injuries; Critical Care; Adult; Female; Airway Extubation; Cohort Studies
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0000000000001725

BACKGROUND:Patients with brain injury are at high risk of extubation failure.
METHODS:We conducted a prospective observational cohort study in four intensive care units of three university hospitals. The aim of the study was to create a score that could predict extubation success in patients with brain injury.
RESULTS:A total of 437 consecutive patients with brain injury were included, and 338 patients (77.3%) displayed successful extubation. In the multivariate analysis, four features were associated with success the day of extubationage less than 40 yr, visual pursuit, swallowing attempts, and a Glasgow coma score greater than 10. In the score, each item counted as one. A score of 3 or greater was associated with 90% extubation success. The area under the receiver–operator curve was 0.75 (95% CI, 0.69 to 0.81). After internal validation by bootstrap, the area under the receiver–operator curve was 0.73 (95% CI, 0.68 to 0.79). Extubation success was significantly associated with shorter duration of mechanical ventilation (11 [95% CI, 5 to 17 days] vs. 22 days [95% CI, 13 to 29 days]; P < 0.0001), shorter intensive care unit length of stay (15 [95% CI, 9 to 23 days] vs. 27 days [95% CI, 21 to 36 days]; P < 0.0001), and lower in-intensive care unit mortality (4 [1.2%] vs. 11 [11.1%]; P < 0.0001).
CONCLUSIONS:Our score exploring both airway functions and neurologic status may increase the probability of successful extubation in patients with severe brain injury.