Development of a risk score to predict extubation failure in patients with traumatic brain injury

Reis, Helena França Correia dos; Gomes‐Neto, Mansueto; Almeida, Mônica Lajana Oliveira de; Silva, Mário Ferreira da; Guedes, Lorena Barreto Arruda; Martinez, Bruno Prata; Rocha, Mário de Seixas

doi:10.1016/j.jcrc.2017.07.051

Cited by 24 publications

(5 citation statements)

References 33 publications

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“…A previous study observed that a quantified score based on sex, Glasgow Coma Scale, sedative dosage, cough reflex, and duration of MV could predict the rate of failed extubation in patients with traumatic brain injury: the rate of extubation failure rose from 3.5% in those with a score of 0 to 3 to 42.9% in patients with a score of 8 to 17. [25] It will be important to determine whether this scoring method could be used clinically to predict the rate of extubation failure in patients without traumatic brain injury, as this would help to select a more appropriate time for extubation and thereby increase the success rate of MV. Some clinical researchers used the decision support system software accompanying the ventilator to set a pressure support level and work of breathing level that were suited to the individual patient, thereby shortening the time to MV removal.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit

Liang¹,

Li²,

Dong³

et al. 2019

Medicine

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Data on outcomes of patients receiving mechanical ventilation (MV) in China are scarce.To investigate factors associated with the prognosis of patients given MV in the intensive care unit (ICU).A 12-year (January 1, 2006–December 31, 2017) retrospective cohort study.ICU of Beijing Geriatric Hospital, China.A total of 905 patients aged ≥16 years given MV during the study period.None.Among 905 patients included (610 men; median age, 78 years; Acute Physiology and Chronic Health Evaluation [APACHE]-II score, 27.3 ± 8.9), 585 survived (388 men; median age, 77 years; average APACHE-II score, 25.6 ± 8.4), and 320 died in the ICU (222 men; median age, 78 years; APACHE-II score, 30.6 ± 8.9). All-cause ICU mortality was 35.4%. In patients aged <65 years, factors associated with ICU mortality were APACHE-II score (odds ratio [OR], 1.108; 95% confidence interval [95% CI], 1.021–1.202; P = .014), nosocomial infection (OR, 6.618; 95% CI, 1.065–41.113; P = .043), acute kidney injury (OR, 17.302; 95% CI, 2.728–109.735; P = .002), invasive hemodynamic monitoring (OR, 10.051; 95% CI, 1.362–74.191; P = .024), MV for cardiopulmonary resuscitation (OR, 0.122; 95% CI, 0.016–0.924; P = .042), duration of MV (OR, 0.993; 95% CI, 0.988–0.998; P = .008), successful weaning from MV (OR, 0.012; 95% CI, 0.002–0.066; P < .001), and renal replacement therapy (OR, 0.039; 95% CI, 0.005–0.324; P = .003). In patients aged ≥65 years, factors associated with mortality were APACHE-II score (OR, 1.062; 95% CI, 1.030–1.096; P < .001), nosocomial infection (OR, 2.427; 95% CI, 1.359–4.334; P = .003), septic shock (OR, 2.017; 95% CI, 1.153–3.529; P = .014), blood transfusion (OR, 1.939; 95% CI, 1.174–3.202; P = .010), duration of MV (OR, 0.999; 95% CI, 0.999–1.000; P = .043), and successful weaning from MV (OR, 0.027; 95% CI, 0.015–0.047; P < .001).APACHE-II score, successful weaning, and nosocomial infection in the ICU are independently associated with the prognosis of patients given MV in the ICU.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit

Liang¹,

Li²,

Dong³

et al. 2019

Medicine

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“…1 ). We identified one additional study by citation searching, for 21 included studies (13, 14, 30–48). Additional study selection details are reported in eTables 1 and 2 (http://links.lww.com/CCM/H268).…”

Section: Resultsmentioning

confidence: 99%

Prognostic Factors Associated With Extubation Failure in Acutely Brain-Injured Patients: A Systematic Review and Meta-Analysis*

Taran

Angeloni

Pinto

et al. 2022

Critical Care Medicine

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Objective: Extubation failure in brain-injured patients is associated with increased morbidity. Our objective was to systematically review prognostic factors associated with extubation failure in acutely brain-injured adult patients receiving invasive ventilation in an ICU. Data Sources: MEDLINE, Embase, and Cochrane Central were searched from inception to January 31, 2022. Study Selection: Two reviewers independently screened citations and selected English-language cohort studies and randomized trials examining the association of prognostic factors with extubation failure. Studies were considered if they included greater than or equal to 80% adult patients with acute brain injury admitted to the ICU and mechanically ventilated for greater than or equal to 24 hours. Data Extraction: Two reviewers extracted data on population, prognostic factors, extubation outcomes, and risk of bias (using the quality in prognostic factors tool). Data Synthesis: In the primary analysis, adjusted odds ratios (aOR) for each prognostic factor were pooled using random-effects models. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The search identified 7,626 citations, of which 21 studies met selection criteria. Moderate-certainty evidence suggested increased risk of extubation failure with older age (aOR, 3.0 for upper vs lower tertile; 95% CI, 1.78–5.07) and longer duration of mechanical ventilation (aOR, 3.47 for upper vs lower tertile; 95% CI, 1.68–7.19). Presence of cough (aOR, 0.40; 95% CI, 0.28–0.57) and intact swallow (aOR, 0.34; 95% CI, 0.21–0.54) probably decreased risk of extubation failure (moderate certainty). Associations of other factors with extubation failure were informed by low or very low certainty evidence. Conclusions: Patient age, duration of mechanical ventilation, and airway reflexes were associated with extubation failure in brain-injured patients with moderate certainty. Future studies are needed to determine the optimal application of these variables in clinical practice.

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“…Cons are the study's observational design, that it was conducted in a single center, and that only patients with stroke and intracranial hemorrhage were admitted. dos Reis Score dos Reis et al [29] published in 2017 a score to estimate extubation failure based on 311 mechanically ventilated patients with traumatic brain injury. Extubation failure was defined as the need for artificial airway reinstitution within 48 h of extubation.…”

Section: Consmentioning

confidence: 99%

Extubation After Acute Brain Injury: An Unsolved Dilemma!!

Godoy,

Rovegno,

Jibaja

2023

Neurocrit Care

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Development of a risk score to predict extubation failure in patients with traumatic brain injury

Cited by 24 publications

References 33 publications

Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit

Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit

Prognostic Factors Associated With Extubation Failure in Acutely Brain-Injured Patients: A Systematic Review and Meta-Analysis*

Extubation After Acute Brain Injury: An Unsolved Dilemma!!

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