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Multicenter Study Observational Study
Extubation Success Prediction in a Multicentric Cohort of Patients with Severe Brain Injury.
- Karim Asehnoune, Philippe Seguin, Sigismond Lasocki, Antoine Roquilly, Adrien Delater, Antoine Gros, Florian Denou, Pierre-Joachim Mahé, Nicolas Nesseler, Dominique Demeure-Dit-Latte, Yoann Launey, Karim L... more
- From the Intensive Care Unit, Anesthesia and Critical Care Department, Hôtel Dieu (K.A., A.R, A.D., P.-J.M., D.D.-d.-L., R.C.), Laboratoire UPRES EA 3826, Thérapeutiques Cliniques et Expérimentales des Inf... more
- Anesthesiology. 2017 Aug 1; 127 (2): 338-346.
BackgroundPatients with brain injury are at high risk of extubation failure.MethodsWe 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.ResultsA 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 extubation: age 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).ConclusionsOur score exploring both airway functions and neurologic status may increase the probability of successful extubation in patients with severe brain injury.
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