학술논문
Evaluating the Sum of Eye and Motor Components of the Glasgow Coma Score As a Predictor of Extubation Failure in Patients With Acute Brain Injury
Document Type
Academic Journal
Author
Taran, Shaurya; Perrot, Bastien; Angriman, Federico; Cinotti, Raphael; Abback, Paër-sélim; Codorniu, Anaïs; Citerio, Giuseppe; Ludovica Sala, Vittoria; Astuto, Marinella; Tringali, Eleonora; Alampi, Daniela; Rocco, Monica; Giuseppina Maugeri, Jessica; Bellissima, Agrippino; Filippini, Matteo; Lazzeri, Nicoletta; Cortegiani, Andrea; Ippolito, Mariachiara; Robba, Chiara; Battaglini, Denise; Biston, Patrick; Fathi Al-Gharyani, Mohamed; Chabanne, Russell; ASTIER, Léo; Soyer, Benjamin; Gaugain, Samuel; Zimmerli, Alice; Pietsch, Urs; Filipovic, Miodrag; Brandi, Giovanna; Bicciato, Giulio; Serrano, Ainhoa; Monleon, Berta; van Vliet, Peter; Marcel Gerretsen, Benjamin; Xochitl Ortiz-Macias, Iris; Oto, Jun; Enomoto, Noriya; Matsuda, Tomomichi; Masui, Nobutaka; Garçon, Pierre; Zarka, Jonathan; Vermeijden, Wytze J; Daniel Cornet, Alexander; Reyes Inurrigarro, Sergio; Cirino Lara Domínguez, Rafael; Mercedes Bellini, Maria; Milagros Gomez Haedo, Maria; Lamot, Laura; Orquera, Jose; Biais, Matthieu; Georges, Delphine; Baronia, Arvind; Carlos Miranda-Ackerman, Roberto; José Barbosa-Camacho, Francisco; Porter, John; Lopez-Morales, Miguel; Geeraerts, Thomas; Compagnon, Baptiste; Pérez-Torres, David; Prol-Silva, Estefanía; Basheer Yahya, Hana; Khaled, Ala; Ghula, Mohamed; Neville Andrea, Cracchiolo; Maria Daniela, Palma; Deana, Cristian; Vetrugno, Luigi; Rivera Chavez, Manuel J.; Mendoza Trujillo, Rocio; LEGROS, Vincent; Brochet, Benjamin; Huet, Olivier; Geslain, Marie; van der Jagt, Mathieu; van Steenkiste, Job; Ahmed, Hazem; Edward Coombs, Alexander; Welbourne, Jessie; Velarde Pineda, Ana Alicia; Nubert Castillo, VÍctor Hugo; Azab, Mohammed A; Azzam, Ahmed Y; Paul van Meenen, David Michael; Adrian Gasca, Gilberto; Arellano, Alfredo; Galicia-Espinosa, Forttino; Carlos García-Ramos, José; Yadav, Ghanshyam; Kumar Jha, Amarendra; Robert-Edan, Vincent; Rodie-Talbere, Pierre-Andre; Jain, Gaurav; Panda, Sagarika; Agarwal, Sonika; Deewan, Yashbir; Adrian Gasca, Gilberto; Arellano, Alfredo; Tariq Reza, Syed; Hossain, Md. Mozaffer; Papadas, Christos; Chantziara, Vasiliki; Sklavou, Chrysanthi; Hourmant, Yannick; Grillot, Nicolas; van Steenkiste, Job; van der Jagt, Mathieu; Pirracchio, Romain; Akkari, Abdelraouf; Abdelaty, Mohamed; Hashim, Ahmed; Launey, Yoann; Masseret, Elodie; Lasocki, Sigismond; Gergaud, Soizic; Mouclier, Nicolas; Saxena, Sulekha; Agrawal, Avinash; Bedanta Mishra, Shakti; Samal, Samir; Cesar Mijangos, Julio; Haënggi, Mattias; Gurjar, Mohan; Schultz, Marcus J; Kaye, Callum; Agustin Godoy, Daniela; Alvarez, Pablo; Ioakeimidou, Aikaterini; Ueno, Yoshitoyo; Badenes, Rafael; Suei Elbuzidi, Abdurrahmaan Ali; Piagnerelli, Michaël; Elhadi, Muhammed; Tariq Reza, Syed; Atef Azab, Mohammed; Catherine Digitale, Jean; Fong, Nicholas; Campos Cerda, Ricardo; de la Torre Peredo, Norma; Pirracchio, Romain; David Stevens, Robert
Source
Critical Care Medicine. Apr 01, 2024
Subject
Language
English
ISSN
0090-3493
Abstract
OBJECTIVES:: To evaluate the association between the pre-extubation sum of eye and motor components of the Glasgow Coma Score (GCS-EM) and odds of extubation failure in patients with acute brain injury being liberated from mechanical ventilation. DESIGN:: Secondary analysis of a prospective, multicenter observational study (ClinicalTrials.gov identifier NCT03400904). SETTING:: Sixty-three hospital sites worldwide, with patient recruitment from January 2018 to November 2020. PATIENTS:: One thousand one hundred fifty-two critically ill patients with acute brain injury, with a median age of 54 years, of whom 783 (68.0%) were male, 559 (48.5%) had traumatic brain injury, and 905 (78.6%) had a GCS-EM greater than 8 before extubation (scores range from 2 to 10). INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: GCS-EM was computed in intubated patients on the day of extubation. The main outcome was extubation failure, defined as unplanned reintubation within 5 days of extubation. Analyses used multilevel logistic regression with adjustment for patient characteristics and a random intercept for hospital site. In the primary analysis, GCS-EM was not associated with extubation failure (odds ratio, 1.07 per additional point; 95% CI, 0.87–1.31). Findings were consistent in sensitivity analyses that: 1) used different adjustment covariates, 2) included a verbal estimate to derive an overall GCS, 3) accounted for missing data, 4) considered a 2-day time interval to define extubation failure, 5) accounted for competing risks, and 6) used a propensity score-based model. There was no association between GCS-EM and extubation outcome in subgroups defined by brain injury diagnosis or age. CONCLUSIONS:: In this large, contemporary, multicenter cohort of patients with acute brain injury, we found no association between the GCS-EM and odds of extubation failure. However, few patients had a pre-extubation GCS-EM less than or equal to 8, and the possibility of a true prognostic association in patients with low scores is not excluded.