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

Karim Asehnoune (1) , Philippe Seguin (2) , Sigismond Lasocki (3) , Antoine Roquilly (1) , Adrien Delater , Antoine Gros , Florian Denou , Pierre-Joachim Mahé , Nicolas Nesseler , Dominique Demeure-Dit-Latte , Yoann Launey , Karim Lakhal , Bertrand Rozec (1) , Yannick Mallédant , Véronique Sébille (4, 1) , Samir Jaber (5, 6) , Aurélie Le Thuaut , Fanny Feuillet (4) , Raphaël Cinotti (1)

1 CHU Nantes - Centre Hospitalier Universitaire de Nantes
2 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
3 CHU Angers - Centre Hospitalier Universitaire d'Angers
4 UN - Université de Nantes
5 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
6 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]

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 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 \textless 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 \textless 0.0001), and lower in-intensive care unit mortality (4 [1.2%] vs. 11 [11.1%]; P \textless 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.

Mots clés: Critical Care; Airway Extubation; Intensive Care Units; Prospective Studies; Brain Injuries; Risk Factors; Length of Stay; Cohort Studies; Middle Aged; Adult; Male; Female; Humans

Domaines: Sciences du Vivant [q-bio]

Karim Asehnoune, Philippe Seguin, Sigismond Lasocki, Antoine Roquilly, Adrien Delater, et al.. Extubation Success Prediction in a Multicentric Cohort of Patients with Severe Brain Injury. Anesthesiology, 2017, 127 (2), pp.338--346. ⟨10.1097/ALN.0000000000001725⟩. ⟨hal-01760471⟩