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Purpose <p>In critically ill patients, extubation readiness is typically assessed using a spontaneous breathing trial (SBT). Among patients with acute brain injury (ABI), the optimal SBT method remains uncertain.</p> Methods <p>We conducted a post-hoc analysis of the ENIO study (NCT03400904), including mechanically ventilated ABI patients with available SBT data, undergoing extubation attempt. SBTs were classified as T-piece, pressure support ventilation (PSV), or continuous positive airway pressure (CPAP). The primary outcome was extubation failure within 5&#xa0;days. Associations between SBT modality and extubation failure were assessed using multivariable logistic regression and inverse probability of treatment weighting.</p> Results <p>Of 1,512 patients enrolled in ENIO, 839 met the inclusion criteria, of whom 270 (32.2%) were female and 396 (47.2%) had traumatic brain injury as the cause of admission. SBTs were performed with PSV in 430 (51.3%), T-piece in 329 (39.2%), and CPAP in 80 (9.5%). SBT median duration was 60&#xa0;min in PSV and T-piece, while 120&#xa0;min in CPAP. Extubation failure occurred in 177 (21.1%) cases. In multivariable analyses, there was no significant association between SBT modality or duration and extubation outcome. Results were similar in ABI subgroup analyses. After inverse probability weighting, vigorous cough remained the only significant predictor of extubation success.</p> Conclusions <p>In this large international ABI cohort, neither SBT mode nor duration was associated with extubation failure.</p>

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Spontaneous breathing trials as predictors of extubation outcomes in neurocritical care: insights from the ENIO study

  • 期刊论文

  • 发表日期：

    2026年1月13日

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  • Denise Battaglini,
  • Shaurya Taran,
  • Francesca Gualdi,
  • Raphael Cinotti,
  • Karim Asehnoune,
  • Andrea Loggini,
  • Luca Montagnani,
  • Patricia R. M. Rocco,
  • Marcus J. Schultz,
  • Nicolò Antonino Patroniti,
  • Chiara Robba,
  • Paër-sélim Abback,
  • Anaïs Codorniu,
  • Giuseppe Citerio,
  • Vittoria Sala,
  • Marinella Astuto,
  • Eleonora Tringali,
  • Daniela Alampi,
  • Monica Rocco,
  • Jessica Maugeri,
  • Agrippino Bellissima,
  • Matteo Filippini,
  • Nicoletta Lazzeri,
  • Andrea Cortegiani,
  • Mariachiara Ippolito,
  • Pasquale Anania,
  • Gianluigi Zona,
  • Pietro Fiaschi,
  • Patrick Biston,
  • Mohamed Al-Gharyani,
  • Russell Chabanne,
  • Léo Astier,
  • Benjamin Soyer,
  • Samuel Gaugain,
  • Alice Zimmerli,
  • Urs Pietsch,
  • Miodrag Filipovic,
  • Giovanna Brandi,
  • Giulio Bicciato,
  • Ainhoa Serrano,
  • Berta Monleon,
  • Peter Vliet,
  • Benjamin Gerretsen,
  • Iris Ortiz-Macias,
  • Jun Oto,
  • Noriya Enomoto,
  • Tomomichi Matsuda,
  • Nobutaka Masui,
  • Pierre Garçon,
  • Jonathan Zarka,
  • Wytze Vermeijden,
  • Alexander Cornet,
  • Sergio Inurrigarro,
  • Rafael Cirino Domínguez,
  • Maria Bellini,
  • Maria Gomez Haedo,
  • Laura Lamot,
  • Jose Orquera,
  • Matthieu Biais,
  • Delphine Georges,
  • Arvind Baronia,
  • Roberto Miranda-Ackerman,
  • Francisco Barbosa-Camacho,
  • John Porter,
  • Miguel Lopez-Morales,
  • Thomas Geeraerts,
  • Baptiste Compagnon,
  • David Pérez-Torres,
  • Estefanía Prol-Silva,
  • Hana Yahya,
  • Ala Khaled,
  • Mohamed Ghula,
  • Andrea Cracchiolo,
  • Daniela Palma,
  • Cristian Deana,
  • Luigi Vetrugno,
  • Manuel J. Chavez,
  • Rocio Trujillo,
  • Vincent Legros,
  • Benjamin Brochet,
  • Olivier Huet,
  • Marie Geslain,
  • Mathieu Van der Jagt,
  • Job Van Steenkiste,
  • Hazem Ahmed,
  • Alexander Coombs,
  • Jessie Welbourne,
  • Ana Velarde Pineda,
  • Víctor Nubert Castillo,
  • Mohammed A. Azab,
  • Ahmed Y. Azzam,
  • David van Meenen,
  • Gilberto Gasca,
  • Alfredo Arellano,
  • Forttino Galicia-Espinosa,
  • José García-Ramos,
  • Ghanshyam Yadav,
  • Amarendra Jha,
  • Vincent Robert-Edan,
  • Pierre-Andre Rodie-Talbere,
  • Gaurav Jain,
  • Sagarika Panda,
  • Sonika Agarwal,
  • Yashbir Deewan,
  • Gilberto Gasca,
  • Alfredo Arellano,
  • Syed Tariq Reza,
  • Md. Mozaffer Hossain,
  • Christos Papadas,
  • Vasiliki Chantziara,
  • Chrysanthi Sklavou,
  • Yannick Hourmant,
  • Nicolas Grillot,
  • Job van Steenkiste,
  • Mathieu van der Jagt,
  • Romain Pirracchio,
  • Abdelraouf Akkari,
  • Mohamed Abdelaty,
  • Ahmed Hashim,
  • Yoann Launey,
  • Elodie Masseret,
  • Sigismond Lasocki,
  • Soizic Gergaud,
  • Nicolas Mouclier,
  • Sulekha Saxena,
  • Avinash Agrawal,
  • Shakti Mishra,
  • Samir Samal,
  • Julio Mijangos,
  • Mattias Haënggi,
  • Mohan Gurjar,
  • Marcus Schultz,
  • Callum Kaye,
  • Daniela Godoy,
  • Pablo Alvarez,
  • Aikaterini Ioakeimidou,
  • Yoshitoyo Ueno,
  • Rafael Badenes,
  • Abdurrahmaan Suei Elbuzidi,
  • Michaël Piagnerelli,
  • Muhammed Elhadi,
  • Syed Reza,
  • Mohammed Azab,
  • Jean Digitale,
  • Nicholas Fong,
  • Ricardo Cerda,
  • Norma Peredo,
  • Romain Pirracchio,
  • Robert Stevens

摘要

Purpose

In critically ill patients, extubation readiness is typically assessed using a spontaneous breathing trial (SBT). Among patients with acute brain injury (ABI), the optimal SBT method remains uncertain.

Methods

We conducted a post-hoc analysis of the ENIO study (NCT03400904), including mechanically ventilated ABI patients with available SBT data, undergoing extubation attempt. SBTs were classified as T-piece, pressure support ventilation (PSV), or continuous positive airway pressure (CPAP). The primary outcome was extubation failure within 5 days. Associations between SBT modality and extubation failure were assessed using multivariable logistic regression and inverse probability of treatment weighting.

Results

Of 1,512 patients enrolled in ENIO, 839 met the inclusion criteria, of whom 270 (32.2%) were female and 396 (47.2%) had traumatic brain injury as the cause of admission. SBTs were performed with PSV in 430 (51.3%), T-piece in 329 (39.2%), and CPAP in 80 (9.5%). SBT median duration was 60 min in PSV and T-piece, while 120 min in CPAP. Extubation failure occurred in 177 (21.1%) cases. In multivariable analyses, there was no significant association between SBT modality or duration and extubation outcome. Results were similar in ABI subgroup analyses. After inverse probability weighting, vigorous cough remained the only significant predictor of extubation success.

Conclusions

In this large international ABI cohort, neither SBT mode nor duration was associated with extubation failure.