• Federico Angriman, AmaralAndre C K BACKBSunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Eddy Fan, Shaurya Taran, Victoria A McCredie, Andrew Baker, Karen J Bosma, Laurent Brochard, AdhikariNeill K JNKJUniversity of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Canada., Brian H Cuthbertson, Damon C Scales, and Niall D Ferguson.
• University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Canada; f.angriman@mail.utoronto.ca.
• Am. J. Respir. Crit. Care Med. 2024 Nov 25.

RationaleWhether extubation immediately after a successful spontaneous breathing trial is associated with clinical benefits in adult patients with acute brain injury is unknown.ObjectivesWe sought to estimate the association between a prompt extubation attempt and ventilator-free days among adult patients with acute brain injury.MethodsWe performed an emulation of a previously designed randomized controlled trial using data from the Toronto Intensive Care Observational Registry in 8 intensive care units in Toronto, Ontario. We included mechanically ventilated adult patients with acute brain injury who had a first successful spontaneous breathing trial. Our main exposure was prompt extubation (i.e., on the same calendar day following the first successful spontaneous breathing trial). The primary outcome was ventilator-free days up to 28 days. We used inverse probability of treatment weighting to adjust for confounding and reported treatment effects using incidence rate ratios (IRR) and 95% confidence intervals (CI).Measurements And Main Results1,406 patients between April 2014 through March 2023 met inclusion criteria. The main reasons for admission were traumatic brain injury (40%), stroke (ischemic or hemorrhagic; 20%), seizures (11%), and subarachnoid hemorrhage (9%). Over half (57%) of patients underwent prompt extubation following their first successful spontaneous breathing trial. Prompt extubation was associated with more ventilator-free days (IRR: 1.24; 95% CI: 1.19 - 1.29) when compared to no prompt extubation.ConclusionsPrompt extubation following a first successful spontaneous breathing trial was associated with more ventilator-free days (up to 28 days) among adults with acute brain injury receiving invasive mechanical ventilation.

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