• Raphaël Cinotti, Julio Cesar Mijangos, Paolo Pelosi, Matthias Haenggi, Mohan Gurjar, Marcus J Schultz, Callum Kaye, Daniel Agustin Godoy, Pablo Alvarez, Aikaterini Ioakeimidou, Yoshitoyo Ueno, Rafael Badenes, Abdurrahmaan Ali Suei Elbuzidi, Michaël Piagnerelli, Muhammed Elhadi, Syed Tariq Reza, Mohammed Atef Azab, Victoria McCredie, Robert D Stevens, Jean Catherine Digitale, Nicholas Fong, Karim Asehnoune, and ENIO Study Group, the PROtective VENTilation network, the European Society of Intensive Care Medicine, the Colegio Mexicano de Medicina Critica, the Atlanréa group and the Société Française d’Anesthésie-Réanimation–SFAR research network.
• Department of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, 44000, Nantes, France.
• Intensive Care Med. 2022 Nov 1; 48 (11): 153915501539-1550.

PurposeNeurocritical 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.MethodsENIO (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.Results1512 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 (CI95) [0.71-0.87] and 0.71 CI95 [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).ConclusionsIn 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.© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.

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