Extubation Success Prediction in a Multicentric Cohort of Patients with Severe Brain Injury. (August 2017)

• Record Type: Journal Article
• 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
• Is Part Of: Anesthesiology. Volume 127:Number 2(2017)
• Publication Date: 2017-08
• Subjects: Anesthesiology -- Periodicals; Anesthetics -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1097/ALN.0000000000001725
• Languages: English
• ISSNs: 0003-3022

Abstract

Abstract : 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 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). Conclusions: Our score exploring both airway functions and neurologic status may increase the probability of successful extubation in patients with severe brain injury. Abstract : In patients who met at least three of the four VISAGE criteria (visual pursuit, swallowing, age, and Glasgow for extubation), successful extubation was achieved in the majority of patients with severe brain injury. The VISAGE score, which can be readily applied at the bedside, has the potential to predict successful extubation, permit earlier extubation, and reduce complications associated with prolonged mechanical ventilation.Supplemental Digital Content is available in the text.