Neuroanesthesia & neurocritical care
Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial
Authors' conclusion
Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity.
Study context
- Population
- Adults with acute brain injury (GCS ≤ 12 before intubation) requiring mechanical ventilation ≥ 24 h, 62 ICUs in 18 countries
- Participants
- 1,217 adults · 62 ICUs · 18 countries
- Comparison
- Higher vs lower mechanical power on hospital days 1, 3 and 7
- Primary endpoint
- Associations between MP and hospital mortality, reintubation, tracheostomy placement and ARDS
Methodological detailspreplanned, multicentre
- Preplanned
- Multicentre
Primary result
As reported in the abstract
MP and clinical outcomes (aRR at 17 J/min vs HD1 median MP 11.9 J/min)
- Median mechanical power (MP) on HD1, J/min [IQR 9.2-15.1]
- 11.9
- Median MP on HD3, J/min [IQR 10-17]
- 13
- Median MP on HD7, J/min [IQR 11-20]
- 14
- Hospital mortality, HD1 MP, adjusted relative risk (aRR)
- 1.22 (95% CI 1.14-1.30)
- Hospital mortality, HD3 MP, aRR
- 1.38 (95% CI 1.23-1.53)
- Reintubation, HD1 MP, aRR
- 1.64 (95% CI 1.57-1.72)
- Tracheostomy, HD7 MP, aRR
- 1.53 (95% CI 1.18-1.99)
- Moderate-severe acute respiratory distress syndrome (ARDS), HD1 MP, aRR
- 2.07 (95% CI 1.56-2.78)
- Moderate-severe ARDS, HD3 MP, aRR
- 1.76 (95% CI 1.41-2.22)
Further findings
Clinical outcomes in the cohort
- Hospital mortality (n = 139)
- 11%
- Extubated by HD7 (n = 536)
- 44%
- Reintubation among extubated (107/536)
- 20%
- Tracheostomy (n = 340)
- 28%
- ARDS (n = 114)
- 9%
- MP overall higher in patients with ARDS, especially higher ARDS severity
Original publication
Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial. Crit Care. Published 20 April 2023. doi:10.
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