Neuroanesthesia & neurocritical care
Association of Noninvasive Respiratory Support with Extubation Outcomes in Brain-injured Patients Receiving Mechanical Ventilation: A Secondary Analysis of the ENIO Prospective Observational Study
Authors' conclusion
In a large cohort of brain-injured patients undergoing liberation from mechanical ventilation, prophylactic use of HFNC and NIPPV were not associated with reintubation.
Study context
- Population
- Mechanically ventilated patients with acute brain injury being liberated from mechanical ventilation
- Participants
- 1,115 participants · 62 hospitals · 19 countries
- Comparison
- Prophylactic high-flow nasal cannula (HFNC) or noninvasive positive pressure ventilation (NIPPV) vs conventional oxygen therapy after extubation
- Primary endpoint
- Reintubation during ICU admission
Methodological detailsmulticentre, mixed-effects logistic regression, Bayesian analysis
- Multicentre
- Mixed-effects logistic regression
- Bayesian analysis
Primary result
As reported in the abstract
Reintubation
Each group vs conventional oxygen therapyOdds ratio (95% CI)
HFNC
0.97(0.54–1.73)
NIPPV
0.63(0.30–1.32)
Further findings
| Outcome | HFNC | NIPPV |
|---|---|---|
| Probability of reduced reintubation (Bayesian analysis, skeptical and data-driven priors) | probability 17% to 34% | probability 46% to 74% |
Postextubation HFNC or NIPPV use
- Received HFNC or NIPPV following extubation
- 267 (23.9%)
Sensitivity analyses
- Findings remained consistent (alternate adjustment, missing data, shorter time frames, competing risks)
Original publication
Association of Noninvasive Respiratory Support with Extubation Outcomes in Brain-injured Patients Receiving Mechanical Ventilation: A Secondary Analysis of the ENIO Prospective Observational Study. Am J Respir Crit Care Med. Published 1 August 2023. doi:10.
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