Neuroanaesthesia & neurocritical care
The use of tier three therapies in acute brain injured patients: Insight from the Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes observational study
Authors' conclusion
Patients with ABI are frequently managed using at least one TTT. Their use varies according to a country's economic resources, the type of ABI, and ICP monitoring and is associated with a higher risk of complications but not with ICU or hospital mortality.
Study context
- Population
- Adults admitted to intensive care unit (ICU) with acute brain injury (ABI), 73 intensive care units (ICUs) in 18 countries, June 2018–November 2020
- Participants
- 1,512 adults · 73 ICUs
- Comparison
- One or more tier three therapies vs no tier three therapies (TTT)
- TTTn = 396
- Primary endpoint
- Incidence of use of TTT and their effect on outcome
Methodological detailsmulticentre, international
- Multicentre
- International
Primary result
As reported in the abstract
Incidence of TTT use · ICU stay
Received at least one TTT
396
26.2%
Received all three TTT
5
0.3%
Further findings
Patient characteristics, TTT vs no TTT
- TTT patients younger
- P < 0.0001
- TTT patients less likely to have preinjury hypertension
- P = 0.0008
- TTT patients less frequently anisocoric within 24 h of ICU admission
- P < 0.0001
No TTT by country income
- No TTT, high-income countries
- 78%
- No TTT, upper middle-income countries
- 60.6%
- No TTT, lower middle-income countries
- 56.6%
- P < 0.0001
TTT use by ABI type and intracranial pressure (ICP) monitoring
- TTT more frequent in traumatic brain injury (TBI) vs other ABI and with invasive ICP monitoring
- P < 0.0001
ICU or hospital mortality
- TTT use not associated with increased ICU or hospital mortality
- P = 0.999
Safety
Complications with TTT use
- Higher incidence of VAP
- P < 0.0001
- Need for tracheostomy
- P = 0.0194
- Prolonged ICU length of stay (LOS)
- P < 0.0001
Original publication
The use of tier three therapies in acute brain injured patients: Insight from the Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes observational study. Eur J Anaesthesiol Intensive Care. Published 26 January 2024. doi:10.
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