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1. Expert-Augmented Machine Learning

Author

Gennatas, E. D., Friedman, J. H., Ungar, L. H., Pirracchio, R., Eaton, E., Reichman, L., Interian, Y., Simone, C. B., Auerbach, A., Delgado, E., Van der Laan, M. J., Solberg, T. D., and Valdes, G.

Subjects
Statistics - Machine Learning, Computer Science - Artificial Intelligence
Abstract

Machine Learning is proving invaluable across disciplines. However, its success is often limited by the quality and quantity of available data, while its adoption by the level of trust that models afford users. Human vs. machine performance is commonly compared empirically to decide whether a certain task should be performed by a computer or an expert. In reality, the optimal learning strategy may involve combining the complementary strengths of man and machine. Here we present Expert-Augmented Machine Learning (EAML), an automated method that guides the extraction of expert knowledge and its integration into machine-learned models. We use a large dataset of intensive care patient data to predict mortality and show that we can extract expert knowledge using an online platform, help reveal hidden confounders, improve generalizability on a different population and learn using less data. EAML presents a novel framework for high performance and dependable machine learning in critical applications.

Published
2019
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2. 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

Author

Taran, S, Perrot, B, Angriman, F, Cinotti, R, Abback, P, Codorniu, A, Citerio, G, Ludovica Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Giuseppina Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Fathi Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, Van Vliet, P, Marcel Gerretsen, B, Xochitl Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Daniel Cornet, A, Reyes Inurrigarro, S, Cirino Lara Dominguez, R, Mercedes Bellini, M, Milagros Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Carlos Miranda-Ackerman, R, Jose Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Basheer Yahya, H, Khaled, A, Ghula, M, Neville Andrea, C, Maria Daniela, P, Deana, C, Vetrugno, L, Rivera Chavez, M, Mendoza Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, Van Der Jagt, M, Van Steenkiste, J, Ahmed, H, Edward Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, Paul Van Meenen, D, Adrian Gasca, G, Arellano, A, Galicia-Espinosa, F, Carlos Garcia-Ramos, J, Yadav, G, Kumar Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Tariq Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Bedanta Mishra, S, Samal, S, Cesar Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Agustin Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Atef Azab, M, Catherine Digitale, J, Fong, N, Campos Cerda, R, De La Torre Peredo, N, David Stevens, R, Taran S., Perrot B., Angriman F., Cinotti R., Abback P. -S., Codorniu A., Citerio G., Ludovica Sala V., Astuto M., Tringali E., Alampi D., Rocco M., Giuseppina Maugeri J., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Fathi Al-Gharyani M., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., Van Vliet P., Marcel Gerretsen B., Xochitl Ortiz-Macias I., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Daniel Cornet A., Reyes Inurrigarro S., Cirino Lara Dominguez R., Mercedes Bellini M., Milagros Gomez Haedo M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Carlos Miranda-Ackerman R., Jose Barbosa-Camacho F., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Basheer Yahya H., Khaled A., Ghula M., Neville Andrea C., Maria Daniela P., Deana C., Vetrugno L., Rivera Chavez M. J., Mendoza Trujillo R., Legros V., Brochet B., Huet O., Geslain M., Van Der Jagt M., Van Steenkiste J., Ahmed H., Edward Coombs A., Welbourne J., Velarde Pineda A. A., Nubert Castillo V. H., Azab M. A., Azzam A. Y., Paul Van Meenen D. M., Adrian Gasca G., Arellano A., Galicia-Espinosa F., Carlos Garcia-Ramos J., Yadav G., Kumar Jha A., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Tariq Reza S., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Bedanta Mishra S., Samal S., Cesar Mijangos J., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Agustin Godoy D., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Atef Azab M., Catherine Digitale J., Fong N., Campos Cerda R., De La Torre Peredo N., David Stevens R., Taran, S, Perrot, B, Angriman, F, Cinotti, R, Abback, P, Codorniu, A, Citerio, G, Ludovica Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Giuseppina Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Fathi Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, Van Vliet, P, Marcel Gerretsen, B, Xochitl Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Daniel Cornet, A, Reyes Inurrigarro, S, Cirino Lara Dominguez, R, Mercedes Bellini, M, Milagros Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Carlos Miranda-Ackerman, R, Jose Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Basheer Yahya, H, Khaled, A, Ghula, M, Neville Andrea, C, Maria Daniela, P, Deana, C, Vetrugno, L, Rivera Chavez, M, Mendoza Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, Van Der Jagt, M, Van Steenkiste, J, Ahmed, H, Edward Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, Paul Van Meenen, D, Adrian Gasca, G, Arellano, A, Galicia-Espinosa, F, Carlos Garcia-Ramos, J, Yadav, G, Kumar Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Tariq Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Bedanta Mishra, S, Samal, S, Cesar Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Agustin Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Atef Azab, M, Catherine Digitale, J, Fong, N, Campos Cerda, R, De La Torre Peredo, N, David Stevens, R, Taran S., Perrot B., Angriman F., Cinotti R., Abback P. -S., Codorniu A., Citerio G., Ludovica Sala V., Astuto M., Tringali E., Alampi D., Rocco M., Giuseppina Maugeri J., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Fathi Al-Gharyani M., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., Van Vliet P., Marcel Gerretsen B., Xochitl Ortiz-Macias I., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Daniel Cornet A., Reyes Inurrigarro S., Cirino Lara Dominguez R., Mercedes Bellini M., Milagros Gomez Haedo M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Carlos Miranda-Ackerman R., Jose Barbosa-Camacho F., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Basheer Yahya H., Khaled A., Ghula M., Neville Andrea C., Maria Daniela P., Deana C., Vetrugno L., Rivera Chavez M. J., Mendoza Trujillo R., Legros V., Brochet B., Huet O., Geslain M., Van Der Jagt M., Van Steenkiste J., Ahmed H., Edward Coombs A., Welbourne J., Velarde Pineda A. A., Nubert Castillo V. H., Azab M. A., Azzam A. Y., Paul Van Meenen D. M., Adrian Gasca G., Arellano A., Galicia-Espinosa F., Carlos Garcia-Ramos J., Yadav G., Kumar Jha A., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Tariq Reza S., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Bedanta Mishra S., Samal S., Cesar Mijangos J., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Agustin Godoy D., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Atef Azab M., Catherine Digitale J., Fong N., Campos Cerda R., De La Torre Peredo N., and David Stevens R.

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 i

Published
2024

6. Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study

Author

Robba, C, Battaglini, D, Abbas, A, Sarrió, E, Cinotti, R, Asehnoune, K, Taccone, F, Rocco, P, Schultz, M, Citerio, G, Stevens, R, Badenes, R, Abback, P, Codorniu, A, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garçon, P, Zarka, J, Vermeijden, W, Cornet, A, Gard, S, Domínguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronial, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Companion, B, Pérez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghulam, M, Andrea, C, Daniela, P, Deana, C, Vertigo, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, García-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haënggi, M, Gurjar, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Mccredie, V, Suei, E, Haenggi, M, Samir, J, Robba, Chiara, Battaglini, Denise, Abbas, Abbas, Sarrió, Ezequiel, Cinotti, Raphael, Asehnoune, Karim, Taccone, Fabio S., Rocco, Patricia R., Schultz, Marcus J., Citerio, Giuseppe, Stevens, Robert David, Badenes, Rafael, Abback, Paër-Sélim, Codorniu, Anaïs, Sala, Vittoria Ludovica, Astuto, Marinella, Tringali, Eleonora, Alampi, Daniela, Rocco, Monica, Maugeri, Jessica Giuseppina, Bellissima, Agrippino, Filippini, Matteo, Lazzeri, Nicoletta, Cortegiani, Andrea, Ippolito, Mariachiara, Biston, Patrick, Al-Gharyani, Mohamed Fathi, 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, Gerretsen, Benjamin Marcel, Ortiz-Macias, Iris Xochitl, Oto, Jun, Enomoto, Noriya, Matsuda, Tomomichi, Masui, Nobutaka, Garçon, Pierre, Zarka, Jonathan, Vermeijden, Wytze J., Cornet, Alexander Daniel, Gard, Sergio Reyes Infra, Domínguez, Rafael Cirino Lara, Bellini, Maria Mercedes, Haedo, Maria Milagros Gomez, Lamot, Laura, Orquera, Jose, Biais, Matthieu, Georges, Delphine, Baronial, Arvind, Miranda-Ackerman, Roberto Carlos, Barbosa-Camacho, Francisco José, Porter, John, Lopez-Morales, Miguel, Geeraerts, Thomas, Companion, Baptiste, Pérez-Torres, David, Prol-Silva, Estefanía, Yahya, Hana Basheer, Khaled, Ala, Ghulam, Mohamed, Andrea, Cracchiolo Neville, Daniela, Palma Maria, Deana, Cristian, Vertigo, Luigi, Chavez, Manuel J. Rivera, Trujillo, Rocio Mendoza, Legros, Vincent, Brochet, Benjamin, Huet, Olivier, Geslain, Marie, van der Jagt, Mathieu, van Steenkiste, Job, Ahmed, Hazem, Coombs, Alexander Edward, Welbourne, Jessie, Pineda, Ana Alicia Velarde, Castillo, Víctor Hugo Nubert, Azab, Mohammed A., Azzam, Ahmed Y., van Meenen, David Michael Paul, Gasca, Gilberto Adrian, Arellano, Alfredo, Galicia-Espinosa, Forttino, García-Ramos, José Carlos, Yadav, Ghanshyam, Jha, Amarendra Kumar, Robert-Edan, Vincent, Rodie-Talbere, Pierre-Andre, Jain, Gaurav, Panda, Sagarika, Agarwal, Sonika, Deewan, Yashbir, Reza, Syed Tariq, Hossain, Md. Mozaffer, Papadas, Christos, Chantziara, Vasiliki, Sklavou, Chrysanthi, Hourmant, Yannick, Grillot, Nicolas, Pirracchio, Romain, Akkari, Abdelraouf, Abdelaty, Mohamed, Hashim, Ahmed, Launey, Yoann, Masseret, Elodie, Lasocki, Sigismond, Gergaud, Soizic, Mouclier, Nicolas, Saxena, Sulekha, Agrawal, Avinash, Mishra, Shakti Bedanta, Samal, Samir, Mijangos, Julio Cesar, Haënggi, Mattias, Gurjar, Mohan, Kaye, Callum, Godoy, Daniela Agustin, Alvarez, Pablo, Ioakeimidou, Aikaterini, Ueno, Yoshitoyo, Elbuzidi, Abdurrahmaan Ali Suei, Piagnerelli, Michaël, Elhadi, Muhammed, Azab, Mohammed Atef, Digitale, Jean Catherine, Fong, Nicholas, Cerda, Ricardo Campos, de la Torre Peredo, Norma, McCredie, Victoria, Suei, Elbuzidi Abdurrahmaan Ali, Haenggi, Matthias, Samir, Jaber, Robba, C, Battaglini, D, Abbas, A, Sarrió, E, Cinotti, R, Asehnoune, K, Taccone, F, Rocco, P, Schultz, M, Citerio, G, Stevens, R, Badenes, R, Abback, P, Codorniu, A, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garçon, P, Zarka, J, Vermeijden, W, Cornet, A, Gard, S, Domínguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronial, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Companion, B, Pérez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghulam, M, Andrea, C, Daniela, P, Deana, C, Vertigo, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, García-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haënggi, M, Gurjar, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Mccredie, V, Suei, E, Haenggi, M, Samir, J, Robba, Chiara, Battaglini, Denise, Abbas, Abbas, Sarrió, Ezequiel, Cinotti, Raphael, Asehnoune, Karim, Taccone, Fabio S., Rocco, Patricia R., Schultz, Marcus J., Citerio, Giuseppe, Stevens, Robert David, Badenes, Rafael, Abback, Paër-Sélim, Codorniu, Anaïs, Sala, Vittoria Ludovica, Astuto, Marinella, Tringali, Eleonora, Alampi, Daniela, Rocco, Monica, Maugeri, Jessica Giuseppina, Bellissima, Agrippino, Filippini, Matteo, Lazzeri, Nicoletta, Cortegiani, Andrea, Ippolito, Mariachiara, Biston, Patrick, Al-Gharyani, Mohamed Fathi, 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, Gerretsen, Benjamin Marcel, Ortiz-Macias, Iris Xochitl, Oto, Jun, Enomoto, Noriya, Matsuda, Tomomichi, Masui, Nobutaka, Garçon, Pierre, Zarka, Jonathan, Vermeijden, Wytze J., Cornet, Alexander Daniel, Gard, Sergio Reyes Infra, Domínguez, Rafael Cirino Lara, Bellini, Maria Mercedes, Haedo, Maria Milagros Gomez, Lamot, Laura, Orquera, Jose, Biais, Matthieu, Georges, Delphine, Baronial, Arvind, Miranda-Ackerman, Roberto Carlos, Barbosa-Camacho, Francisco José, Porter, John, Lopez-Morales, Miguel, Geeraerts, Thomas, Companion, Baptiste, Pérez-Torres, David, Prol-Silva, Estefanía, Yahya, Hana Basheer, Khaled, Ala, Ghulam, Mohamed, Andrea, Cracchiolo Neville, Daniela, Palma Maria, Deana, Cristian, Vertigo, Luigi, Chavez, Manuel J. Rivera, Trujillo, Rocio Mendoza, Legros, Vincent, Brochet, Benjamin, Huet, Olivier, Geslain, Marie, van der Jagt, Mathieu, van Steenkiste, Job, Ahmed, Hazem, Coombs, Alexander Edward, Welbourne, Jessie, Pineda, Ana Alicia Velarde, Castillo, Víctor Hugo Nubert, Azab, Mohammed A., Azzam, Ahmed Y., van Meenen, David Michael Paul, Gasca, Gilberto Adrian, Arellano, Alfredo, Galicia-Espinosa, Forttino, García-Ramos, José Carlos, Yadav, Ghanshyam, Jha, Amarendra Kumar, Robert-Edan, Vincent, Rodie-Talbere, Pierre-Andre, Jain, Gaurav, Panda, Sagarika, Agarwal, Sonika, Deewan, Yashbir, Reza, Syed Tariq, Hossain, Md. Mozaffer, Papadas, Christos, Chantziara, Vasiliki, Sklavou, Chrysanthi, Hourmant, Yannick, Grillot, Nicolas, Pirracchio, Romain, Akkari, Abdelraouf, Abdelaty, Mohamed, Hashim, Ahmed, Launey, Yoann, Masseret, Elodie, Lasocki, Sigismond, Gergaud, Soizic, Mouclier, Nicolas, Saxena, Sulekha, Agrawal, Avinash, Mishra, Shakti Bedanta, Samal, Samir, Mijangos, Julio Cesar, Haënggi, Mattias, Gurjar, Mohan, Kaye, Callum, Godoy, Daniela Agustin, Alvarez, Pablo, Ioakeimidou, Aikaterini, Ueno, Yoshitoyo, Elbuzidi, Abdurrahmaan Ali Suei, Piagnerelli, Michaël, Elhadi, Muhammed, Azab, Mohammed Atef, Digitale, Jean Catherine, Fong, Nicholas, Cerda, Ricardo Campos, de la Torre Peredo, Norma, McCredie, Victoria, Suei, Elbuzidi Abdurrahmaan Ali, Haenggi, Matthias, and Samir, Jaber

Abstract

Purpose: The use of arterial partial pressure of carbon dioxide (PaCO2) as a target intervention to manage elevated intracranial pressure (ICP) and its effect on clinical outcomes remain unclear. We aimed to describe targets for PaCO2 in acute brain injured (ABI) patients and assess the occurrence of abnormal PaCO2 values during the first week in the intensive care unit (ICU). The secondary aim was to assess the association of PaCO2 with in-hospital mortality. Methods: We carried out a secondary analysis of a multicenter prospective observational study involving adult invasively ventilated patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracranial hemorrhage (ICH), or ischemic stroke (IS). PaCO2 was collected on day 1, 3, and 7 from ICU admission. Normocapnia was defined as PaCO2 > 35 and to 45 mmHg; mild hypocapnia as 32–35 mmHg; severe hypocapnia as 26–31 mmHg, forced hypocapnia as < 26 mmHg, and hypercapnia as > 45 mmHg. Results: 1476 patients (65.9% male, mean age 52 ± 18 years) were included. On ICU admission, 804 (54.5%) patients were normocapnic (incidence 1.37 episodes per person/day during ICU stay), and 125 (8.5%) and 334 (22.6%) were mild or severe hypocapnic (0.52 and 0.25 episodes/day). Forced hypocapnia and hypercapnia were used in 40 (2.7%) and 173 (11.7%) patients. PaCO2 had a U-shape relationship with in-hospital mortality with only severe hypocapnia and hypercapnia being associated with increased probability of in-hospital mortality (omnibus p value = 0.0009). Important differences were observed across different subgroups of ABI patients. Conclusions: Normocapnia and mild hypocapnia are common in ABI patients and do not affect patients' outcome. Extreme derangements of PaCO2 values were significantly associated with increased in-hospital mortality.

Published
2024

8. 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

Author

Wahlster, S, Sharma, M, Taran, S, Town, J, Stevens, R, Cinotti, R, Asehoune, K, Pelosi, P, Robba, C, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Wahlster S., Sharma M., Taran S., Town J. A., Stevens R. D., Cinotti R., Asehoune K., Pelosi P., Robba C., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Velarde Pineda A. A., Nubert Castillo V. H., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., de la Torre Peredo N., Wahlster, S, Sharma, M, Taran, S, Town, J, Stevens, R, Cinotti, R, Asehoune, K, Pelosi, P, Robba, C, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Wahlster S., Sharma M., Taran S., Town J. A., Stevens R. D., Cinotti R., Asehoune K., Pelosi P., Robba C., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Velarde Pineda A. A., Nubert Castillo V. H., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., and de la Torre Peredo N.

Abstract

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2–15.1], 13 J/min [IQR 10–17], and 14 J/min [IQR 11–20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14–1.30) and HD3 (1.38, 95% CI 1.23–1.53), reintubation on HD1 (1.64; 95% CI 1.57–1.72), and tracheostomy on HD7 (1

Published
2023

9. Individualized Thresholds of Hypoxemia and Hyperoxemia and their Effect on Outcome in Acute Brain Injured Patients: A Secondary Analysis of the ENIO Study

Author

Robba, C, Battaglini, D, Cinotti, R, Asehnoune, K, Stevens, R, Taccone, F, Badenes, R, Pelosi, P, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Agrippino, B, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez-Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Cracchiolo Neville, A, Palma, M, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Robba C., Battaglini D., Cinotti R., Asehnoune K., Stevens R., Taccone F. S., Badenes R., Pelosi P., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Agrippino B., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez-Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Cracchiolo Neville A., Palma M. D., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Elbuzidi A. A. S., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., de la Torre Peredo N., Robba, C, Battaglini, D, Cinotti, R, Asehnoune, K, Stevens, R, Taccone, F, Badenes, R, Pelosi, P, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Agrippino, B, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez-Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Cracchiolo Neville, A, Palma, M, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Robba C., Battaglini D., Cinotti R., Asehnoune K., Stevens R., Taccone F. S., Badenes R., Pelosi P., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Agrippino B., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez-Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Cracchiolo Neville A., Palma M. D., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Elbuzidi A. A. S., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., and de la Torre Peredo N.

Abstract

Background: In acute brain injury (ABI), the effects of hypoxemia as a potential cause of secondary brain damage and poor outcome are well documented, whereas the impact of hyperoxemia is unclear. The primary aim of this study was to assess the episodes of hypoxemia and hyperoxemia in patients with ABI during the intensive care unit (ICU) stay and to determine their association with in-hospital mortality. The secondary aim was to identify the optimal thresholds of arterial partial pressure of oxygen (PaO2) predicting in-hospital mortality. Methods: We conducted a secondary analysis of a prospective multicenter observational cohort study. Adult patients with ABI (traumatic brain injury, subarachnoid aneurysmal hemorrhage, intracranial hemorrhage, ischemic stroke) with available data on PaO2 during the ICU stay were included. Hypoxemia was defined as PaO2 < 80 mm Hg, normoxemia was defined as PaO2 between 80 and 120 mm Hg, mild/moderate hyperoxemia was defined as PaO2 between 121 and 299 mm Hg, and severe hyperoxemia was defined as PaO2 levels ≥ 300 mm Hg. Results: A total of 1,407 patients were included in this study. The mean age was 52 (±18) years, and 929 (66%) were male. Over the ICU stay, the fractions of patients in the study cohort who had at least one episode of hypoxemia, mild/moderate hyperoxemia, and severe hyperoxemia were 31.3%, 53.0%, and 1.7%, respectively. PaO2 values below 92 mm Hg and above 156 mm Hg were associated with an increased probability of in-hospital mortality. Differences were observed among subgroups of patients with ABI, with consistent effects only seen in patients without traumatic brain injury. Conclusions: In patients with ABI, hypoxemia and mild/moderate hyperoxemia were relatively frequent. Hypoxemia and hyperoxemia during ICU stay may influence in-hospital mortality. However, the small number of oxygen values collected represents a major limitation of the study.

Published
2023

10. Risk factors of extubation failure in neurocritical patients with the most impaired consciousness

Author

de Courson, H, Massart, N, Asehnoune, K, Cinotti, R, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espino-sa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Fong, N, Digitale, J, Stevens, R, Mijangos, J, Haenngi, M, Gurjar, M, Schultz, M, Godoy, D, Alvarez, P, Kaye, C, Ioakeimidou, A, Ueno, Y, Badenes, R, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Cerda, R, Peredo, N, de Courson H., Massart N., Asehnoune K., Cinotti R., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espino-sa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Fong N., Digitale J., Stevens R., Mijangos J. C., Haenngi M., Gurjar M., Schultz M., Godoy D. A., Alvarez P., Kaye C., Ioakeimidou A., Ueno Y., Badenes R., Elbuzidi A. S., Piagnerelli M., Elhadi M., Cerda R., Peredo N., de Courson, H, Massart, N, Asehnoune, K, Cinotti, R, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espino-sa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Fong, N, Digitale, J, Stevens, R, Mijangos, J, Haenngi, M, Gurjar, M, Schultz, M, Godoy, D, Alvarez, P, Kaye, C, Ioakeimidou, A, Ueno, Y, Badenes, R, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Cerda, R, Peredo, N, de Courson H., Massart N., Asehnoune K., Cinotti R., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espino-sa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Fong N., Digitale J., Stevens R., Mijangos J. C., Haenngi M., Gurjar M., Schultz M., Godoy D. A., Alvarez P., Kaye C., Ioakeimidou A., Ueno Y., Badenes R., Elbuzidi A. S., Piagnerelli M., Elhadi M., Cerda R., and Peredo N.

Published
2023

12. Extubation in neurocritical care patients: the ENIO international prospective study

Author

Cinotti, R, Mijangos, J, Pelosi, P, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Reza, S, Azab, M, Mccredie, V, Stevens, R, Digitale, J, Fong, N, Asehnoune, K, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Cinotti R., Mijangos J. C., Pelosi P., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Reza S. T., Azab M. A., McCredie V., Stevens R. D., Digitale J. C., Fong N., Asehnoune K., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Cinotti, R, Mijangos, J, Pelosi, P, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Reza, S, Azab, M, Mccredie, V, Stevens, R, Digitale, J, Fong, N, Asehnoune, K, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Cinotti R., Mijangos J. C., Pelosi P., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Reza S. T., Azab M. A., McCredie V., Stevens R. D., Digitale J. C., Fong N., Asehnoune K., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., and Samal S.

Abstract

Purpose: Neurocritical care patients receive prolonged invasive mechanical ventilation (IMV), but there is poor specific information in this high-risk population about the liberation strategies of invasive mechanical ventilation. Methods: ENIO (NCT03400904) is an international, prospective observational study, in 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Neurocritical care patients with a Glasgow Coma Score (GCS) ≤ 12, receiving IMV ≥ 24 h, undergoing extubation attempt or tracheostomy were included. The primary endpoint was extubation failure by day 5. An extubation success prediction score was created, with 2/3 of patients randomly allocated to the training cohort and 1/3 to the validation cohort. Secondary endpoints were the duration of IMV and in-ICU mortality. Results: 1512 patients were included. Among the 1193 (78.9%) patients who underwent an extubation attempt, 231 (19.4%) failures were recorded. The score for successful extubation prediction retained 20 variables as independent predictors. The area under the curve (AUC) in the training cohort was 0.79 95% confidence interval (CI95) [0.71–0.87] and 0.71 CI95 [0.61–0.81] in the validation cohort. Patients with extubation failure displayed a longer IMV duration (14 [7–21] vs 6 [3–11] days) and a higher in-ICU mortality rate (8.7% vs 2.4%). Three hundred and nineteen (21.1%) patients underwent tracheostomy without extubation attempt. Patients with direct tracheostomy displayed a longer duration of IMV and higher in-ICU mortality than patients with an extubation attempt (success and failure). Conclusions: In neurocritical care patients, extubation failure is high and is associated with unfavourable outcomes. A score could predict extubation success in multiple settings. However, it will be mandatory to validate our findings in another prospective independent cohort.

Published
2022

15. Patient-Level Meta-Analysis of Low-Dose Hydrocortisone in Adults with Septic Shock

Author

Pirracchio, R, Annane, D, Waschka, AK, Lamontagne, F, Arabi, YM, Bollaert, P-E, Billot, L, Du, B, Briegel, J, Cohen, J, Finfer, S, Gordon, A, Hammond, N, Hyvernat, H, Keh, D, Li, Y, Liu, L, Meduri, GU, Mirea, L, Myburgh, JA, Sprung, CL, Tilouche, N, Tongyoo, S, Venkatesh, B, Zheng, R, Delaney, A, and NIHR

Abstract

BACKGROUND Trials and study-level meta-analyses have failed to resolve the role of corticosteroids in the management of patients with septic shock. Patient-level meta-analyses may provide more precise estimates of treatment effects, particularly subgroup effects. METHODS We pooled individual patient data from septic shock trials investigating the adjunctive use of intravenous hydrocortisone. The primary outcome was 90-day all-cause mortality, and it was also analyzed across predefined subgroups. Secondary outcomes included mortality at intensive care unit and hospital discharge, at 28 and 180 days, and vasopressor-, ventilator-, and organ failure–free days. Adverse events included superinfection, muscle weakness, hyperglycemia, hypernatremia, and gastroduodenal bleeding. RESULTS Of 24 eligible trials (n=8528), 17 (n=7882) provided individual patient data, and 7 (n=5929) provided 90-day mortality. The marginal relative risk (RR) for 90-day mortality of hydrocortisone versus placebo was 0.93 (95% confidence interval [CI], 0.82 to 1.04; P=0.22; moderate certainty). It was 0.86 (9% CI, 0.79 to 0.92) for hydrocortisone with fludrocortisone and 0.96 (95% CI, 0.82 to 1.12) without fludrocortisone. There was no significant differential treatment effect across subgroups. Hydrocortisone was associated with little to no difference in any of the secondary outcomes except vasopressor-free days (mean difference, 1.24 days; 95% CI, 0.74 to 1.73; high certainty). Hydrocortisone may not be associated with an increase in the risk of superinfection (RR, 1.04; 95% CI, 0.95 to 1.15; low certainty), hyperglycemia (RR, 1.05; 95% CI, 0.98 to 1.12; low certainty), or gastroduodenal bleeding (RR, 1.11; 95% CI, 0.83 to 1.48; low certainty). Hydrocortisone may be associated with an increase in the risk of hypernatremia (RR, 2.01; 95% CI, 1.56 to 2.60; low certainty) and muscle weakness (n=2647; RR, 1.73; 95% CI, 1.49 to 1.99; low certainty). CONCLUSIONS In this patient-level meta-analysis, hydrocortisone compared with placebo was not associated with reduced mortality for patients with septic shock. (Funded by “Programme d’Investissements d’Avenir,” a research Professorship from the National Institute of Health and Care Research, Leadership Fellowships from the National Health and Medical Research Council of Australia, and Emerging Leaders Fellowship from the National Health and Medical Research Council of Australia; PROSPERO registration number, CRD42017062198.)

Published
2023
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16. ESICM LIVES 2016: part three: Milan, Italy. 1–5 October 2016

Author

Velasquez, T., Mackey, G., Lusk, J., Kyle, U. G., Fontenot, T., Marshall, P., Shekerdemian, L. S., Coss-Bu, J. A., Nishigaki, A., Yatabe, T., Tamura, T., Yamashita, K., Yokoyama, M., Ruiz-Rodriguez, J. C., Encina, B., Belmonte, R., Troncoso, I., Tormos, P., Riveiro, M., Baena, J., Sanchez, A., Bañeras, J., Cordón, J., Duran, N., Ruiz, A., Caballero, J., Nuvials, X., Riera, J., Serra, J., Rutten, A. M. F., van Ieperen, S. N. M., Der Kinderen, E. P. H. M., Van Logten, T., Kovacikova, L., Skrak, P., Zahorec, M., Kyle, U. G., Akcan-Arikan, A., Silva, J. C., Mackey, G., Lusk, J., Goldsworthy, M., Shekerdemian, L. S., Coss-Bu, J. A., Wood, D., Harrison, D., Parslow, R., Davis, P., Pappachan, J., Goodwin, S., Ramnarayan, P., Chernyshuk, S., Yemets, H., Zhovnir, V., Pulitano’, S. M., De Rosa, S., Mancino, A., Villa, G., Tosi, F., Franchi, P., Conti, G., Patel, B., Khine, H., Shah, A., Sung, D., Singer, L., Haghbin, S., Inaloo, S., Serati, Z., Idei, M., Nomura, T., Yamamoto, N., Sakai, Y., Yoshida, T., Matsuda, Y., Yamaguchi, Y., Takaki, S., Yamaguchi, O., Goto, T., Longani, N., Medar, S., Abdel-Aal, I. R., El Adawy, A. S., Mohammed, H. M. E. H., Mohamed, A. N., Parry, S. M., Knight, L. D., Denehy, L., De Morton, N., Baldwin, C. E., Sani, D., Kayambu, G., da Silva, V. Z. M., Phongpagdi, P., Puthucheary, Z. A., Granger, C. L., Rydingsward, J. E., Horkan, C. M., Christopher, K. B., McWilliams, D., Jones, C., Reeves, E., Atkins, G., Snelson, C., Aitken, L. M., Rattray, J., Kenardy, J., Hull, A. M., Ullman, A., Le Brocque, R., Mitchell, M., Davis, C., Macfarlane, B., Azevedo, J. C., Rocha, L. L., De Freitas, F. F. M., Cavalheiro, A. M., Lucinio, N. M., Lobato, M. S., Ebeling, G., Kraegpoeth, A., Laerkner, E., De Brito-Ashurst, I., White, C., Gregory, S., Forni, L. G., Flowers, E., Curtis, A., Wood, C. A., Siu, K., Venkatesan, K., Muhammad, J. B. H., Ng, L., Seet, E., Baptista, N., Escoval, A., Tomas, E., Agrawal, R., Mathew, R., Varma, A., Dima, E., Charitidou, E., Perivolioti, E., Pratikaki, M., Vrettou, C., Giannopoulos, A., Zakynthinos, S., Routsi, C., Atchade, E., Houzé, S., Jean-Baptiste, S., Thabut, G., Genève, C., Tanaka, S., Lortat-Jacob, B., Augustin, P., Desmard, M., Montravers, P., de Molina, F. J. González, Barbadillo, S., Alejandro, R., Álvarez-Lerma, F., Vallés, J., Catalán, R. M., Palencia, E., Jareño, A., Granada, R. M., Ignacio, M. L., Cui, N., Liu, D., Wang, H., Su, L., Qiu, H., Li, R., Jaffal, K., Rouzé, A., Poissy, J., Sendid, B., Nseir, S., Paramythiotou, E., Rizos, M., Frantzeskaki, F., Antoniadou, A., Vourli, S., Zerva, L., Armaganidis, A., Riera, J., Gottlieb, J., Greer, M., Wiesner, O., Martínez, M., Acuña, M., Rello, J., Welte, T., Atchade, E., Mignot, T., Houzé, S., Jean-Baptiste, S., Thabut, G., Lortat-Jacob, B., Tanaka, S., Augustin, P., Desmard, M., Montravers, P., Soussi, S., Dudoignon, E., Ferry, A., Chaussard, M., Benyamina, M., Alanio, A., Touratier, S., Chaouat, M., Lafaurie, M., Mimoun, M., Mebazaa, A., Legrand, M., Sheils, M. A., Patel, C., Mohankumar, L., Akhtar, N., Noriega, S. K. Pacheco, Aldana, N. Navarrete, León, J. L. Ávila, Baquero, J. Durand, Bernal, F. Fernández, Ahmadnia, E., Hadley, J. S., Millar, M., Hall, D., Hewitt, H., Yasuda, H., Sanui, M., Komuro, T., Kawano, S., Andoh, K., Yamamoto, H., Noda, E., Hatakeyama, J., Saitou, N., Okamoto, H., Kobayashi, A., Takei, T., Matsukubo, S., Rotzel, H. B., Lázaro, A. Serrano, Prada, D. Aguillón, Gimillo, M. Rodriguez, Barinas, O. Diaz, Cortes, M. L. Blasco, Franco, J. Ferreres, Roca, J. M. Segura, Carratalá, A., Gonçalves, B., Turon, R., Mendes, A., Miranda, F., Mata, P. J., Cavalcanti, D., Melo, N., Lacerda, P., Kurtz, P., Righy, C., Rosario, L. E. de la Cruz, Lesmes, S. P. Gómez, Romero, J. C. García, Herrera, A. N. García, Pertuz, E. D. Díaz, Sánchez, M. J. Gómez, Sanz, E. Regidor, Hualde, J. Barado, Hernández, A. Ansotegui, Irazabal, J. M. Guergué, Spatenkova, V., Bradac, O., Suchomel, P., Urli, T., Lazzeri, E. Heusch, Aspide, R., Zanello, M., Perez-Borrero, L., Garcia-Alvarez, J. M., Arias-Verdu, M. D., Aguilar-Alonso, E., Rivera-Fernandez, R., Mora-Ordoñez, J., De La Fuente-Martos, C., Castillo-Lorente, E., Guerrero-Lopez, F., Lesmes, S. P. Gómez, Rosario, L. E. De la Cruz, Pertuz, E. D. Díaz, Hernández, A. Ansotegui, Romero, J. C. García, Sánchez, M. J. Gómez, Herrera, A. N. García, Ramírez, J. Roldán, Sanz, E. Regidor, Hualde, J. Barado, León, J. P. Tirapu, Navarro-Guillamón, L., Cordovilla-Guardia, S., Iglesias-Santiago, A., Guerrero-López, F., Fernández-Mondéjar, E., Vidal, A., Perez, M., Juez, A., Arias, N., Colino, L., Perez, J. L., Pérez, H., Calpe, P., Alcala, M. A., Robaglia, D., Perez, C., Lan, S. K., Cunha, M. M., Moreira, T., Santos, F., Lafuente, E., Fernandes, M. J., Silva, J. G., Rosario, L. E. de la Cruz, Lesmes, S. P. Gómez, Herrera, A. N. García, Romero, J. C. García, Pertuz, E. D. Díaz, Sánchez, M. J. Gómez, Sanz, E. Regidor, Echeverría, J. G. Armando, Hernández, A. Ansotegui, Hualde, J. Barado, Podlepich, V., Sokolova, E., Alexandrova, E., Lapteva, K., Kurtz, P., Shuinotsuka, C., Rabello, L., Vianna, G., Reis, A., Cairus, C., Salluh, J., Bozza, F., Torres, J. C. Barrios, Araujo, N. J. Fernández, García-Olivares, P., Keough, E., Dalorzo, M., Tang, L. K., De Sousa, I., Díaz, M., Marcos-Zambrano, L. J., Guerrero, J. E., Gomez, S. E. Zamora, Lopez, G. D. Hernandez, Cuellar, A. I. Vazquez, Nieto, O. R. Perez, Gonzalez, J. A. Castanon, Bhasin, D., Rai, S., Singh, H., Gupta, O., Bhattal, M. K., Sampley, S., Sekhri, K., Nandha, R., Aliaga, F. A., Olivares, F., Appiani, F., Farias, P., Alberto, F., Hernández, A., Pons, S., Sonneville, R., Bouadma, L., Neuville, M., Mariotte, E., Radjou, A., Lebut, J., Chemam, S., Voiriot, G., Dilly, M. P., Mourvillier, B., Dorent, R., Nataf, P., Wolff, M., Timsit, J. F., Ediboglu, O., Ataman, S., Ozkarakas, H., Kirakli, C., Vakalos, A., Avramidis, V., Obukhova, O., Kurmukov, I. A., Kashiya, S., Golovnya, E., Baikova, V. N., Ageeva, T., Haritydi, T., Kulaga, E. V., Rios-Toro, J. J., Perez-Borrero, L., Aguilar-Alonso, E., Arias-Verdu, M. D., Garcia-Alvarez, J. M., Lopez-Caler, C., De La Fuente-Martos, C., Rodriguez-Fernandez, S., Sanchez-Orézzoli, M. Gomez, Martin-Gallardo, F., Nikhilesh, J., Joshi, V., Villarreal, E., Ruiz, J., Gordon, M., Quinza, A., Gimenez, J., Piñol, M., Castellanos, A., Ramirez, P., Jeon, Y. D., Jeong, W. Y., Kim, M. H., Jeong, I. Y., Ahn, M. Y., Ahn, J. Y., Han, S. H., Choi, J. Y., Song, Y. G., Kim, J. M., Ku, N. S., Shah, H., Kellner, F., Rezai, F., Mistry, N., Yodice, P., Ovnanian, V., Fless, K., Handler, E., Alejos, R. Martínez, Romeu, J. D. Martí, Antón, D. González, Quinart, A., Martí, A. Torres, Llaurado-Serra, M., Lobo-Civico, A., Ventura-Rosado, A., Piñol-Tena, A., Pi-Guerrero, M., Paños-Espinosa, C., Peralvo-Bernat, M., Marine-Vidal, J., Gonzalez-Engroba, R., Montesinos-Cerro, N., Treso-Geira, M., Valeiras-Valero, A., Martinez-Reyes, L., Sandiumenge, A., Jimenez-Herrera, M. F., Helyar, S., Riozzi, P., Noon, A., Hallows, G., Cotton, H., Keep, J., Hopkins, P. A., Taggu, A., Renuka, S., Sampath, S., Rood, P. J. T., Frenzel, T., Verhage, R., Bonn, M., Pickkers, P., van der Hoeven, J. G., van den Boogaard, M., Corradi, F., Melnyk, L., Moggia, F., Pienovi, R., Adriano, G., Brusasco, C., Mariotti, L., Lattuada, M., Bloomer, M. J., Coombs, M., Ranse, K., Endacott, R., Maertens, B., Blot, K., Blot, S., Amerongen, M. P. van Nieuw, van der Heiden, E. S., Twisk, J. W. R., Girbes, A. R. J., Spijkstra, J. J., Riozzi, P., Helyar, S., Cotton, H., Hallows, G., Noon, A., Bell, C., Peters, K., Feehan, A., Keep, J., Hopkins, P. A., Churchill, K., Hawkins, K., Brook, R., Paver, N., Endacott, R., Maistry, N., van Wijk, A., Rouw, N., van Galen, T., Evelein-Brugman, S., Taggu, A., Krishna, B., Sampath, S., Putzu, A., Fang, M., Berto, M. Boscolo, Belletti, A., Cassina, T., Cabrini, L., Mistry, M., Alhamdi, Y., Welters, I., Abrams, S. T., Toh, C. H., Han, H. S., Gil, E. M., Lee, D. S., Park, C. M., Winder-Rhodes, S., Lotay, R., Doyle, J., Ke, M. W., Huang, W. C., Chiang, C. H., Hung, W. T., Cheng, C. C., Lin, K. C., Lin, S. C., Chiou, K. R., Wann, S. R., Shu, C. W., Kang, P. L., Mar, G. Y., Liu, C. P., Dubó, S., Aquevedo, A., Jibaja, M., Berrutti, D., Labra, C., Lagos, R., García, M. F., Ramirez, V., Tobar, M., Picoita, F., Peláez, C., Carpio, D., Alegría, L., Hidalgo, C., Godoy, K., Bakker, J., Hernández, G., Sadamoto, Y., Katabami, K., Wada, T., Ono, Y., Maekawa, K., Hayakawa, M., Sawamura, A., Gando, S., Marin-Mateos, H., Perez-Vela, J. L., Garcia-Gigorro, R., Peiretti, M. A. Corres, Lopez-Gude, M. J., Chacon-Alves, S., Renes-Carreño, E., Montejo-González, J. C., Parlevliet, K. L., Touw, H. R. W., Beerepoot, M., Boer, C., Elbers, P. W. G., Tuinman, P. R., Abdelmonem, S. A., Helmy, T. A., El Sayed, I., Ghazal, S., Akhlagh, S. H., Masjedi, M., Hozhabri, K., Kamali, E., Zýková, I., Paldusová, B., Sedlák, P., Morman, D., Youn, A. M., Ohta, Y., Sakuma, M., Bates, D., Morimoto, T., Su, P. L., Chang, W. Y., Lin, W. C., Chen, C. W., Facchin, F., Zarantonello, F., Panciera, G., De Cassai, A., Venrdramin, A., Ballin, A., Tonetti, T., Persona, P., Ori, C., Del Sorbo, L., Rossi, S., Vergani, G., Cressoni, M., Chiumello, D., Chiurazzi, C., Brioni, M., Algieri, I., Tonetti, T., Guanziroli, M., Colombo, A., Tomic, I., Colombo, A., Crimella, F., Carlesso, E., Gasparovic, V., Gattinoni, L., Neto, A. Serpa, Schmidt, M., Pham, T., Combes, A., de Abreu, M. Gama, Pelosi, P., Schultz, M. J., Katira, B. H., Engelberts, D., Giesinger, R. E., Ackerley, C., Yoshida, T., Zabini, D., Otulakowski, G., Post, M., Kuebler, W. M., McNamara, P. J., Kavanagh, B. P., Pirracchio, R., Rigon, M. Resche, Carone, M., Chevret, S., Annane, D., Eladawy, S., El-Hamamsy, M., Bazan, N., Elgendy, M., De Pascale, G., Vallecoccia, M. S., Cutuli, S. L., Di Gravio, V., Pennisi, M. A., Conti, G., Antonelli, M., Andreis, D. T., Khaliq, W., Singer, M., Hartmann, J., Harm, S., Carmona, S. Alcantara, Almudevar, P. Matia, Abellán, A. Naharro, Ramos, J. Veganzones, Pérez, L. Pérez, Valbuena, B. Lobo, Sanz, N. Martínez, Simón, I. Fernández, Arrigo, M., Feliot, E., Deye, N., Cariou, A., Guidet, B., Jaber, S., Leone, M., Resche-Rigon, M., Baron, A. Vieillard, Legrand, M., Gayat, E., Mebazaa, A., Balik, M., Kolnikova, I., Maly, M., Waldauf, P., Tavazzi, G., Kristof, J., Herpain, A., Su, F., Post, E., Taccone, F., Vincent, J. L., Creteur, J., Lee, C., Hatib, F., Jian, Z., Buddi, S., Cannesson, M., Fileković, S., Turel, M., Knafelj, R., Gorjup, V., Stanić, R., Gradišek, P., Cerović, O., Mirković, T., Noč, M., Tirkkonen, J., Hellevuo, H., Olkkola, K. T., Hoppu, S., Lin, K. C., Hung, W. T., Chiang, C. C., Huang, W. C., Juan, W. C., Lin, S. C., Cheng, C. C., Lin, P. H., Fong, K. Y., Hou, D. S., Kang, P. L., Wann, S. R., Chen, Y. S., Mar, G. Y., Liu, C. P., Paul, M., Bougouin, W., Geri, G., Dumas, F., Champigneulle, B., Legriel, S., Charpentier, J., Mira, J. P., Sandroni, C., Cariou, A., Zimmerman, J., Sullivan, E., Noursadeghi, M., Fox, B., Sampson, D., McHugh, L., Yager, T., Cermelli, S., Seldon, T., Bhide, S., Brandon, R. A., Brandon, R. B., Zwaag, J., Beunders, R., Pickkers, P., Kox, M., Gul, F., Arslantas, M. K., Genc, D., Zibandah, N., Topcu, L., Akkoc, T., Cinel, I., Greco, E., Lauretta, M. P., Andreis, D. T., Singer, M., Garcia, I. Palacios, Cordero, M., Martin, A. Diaz, Pallás, T. Aldabó, Montero, J. Garnacho, Rey, J. Revuelto, Malo, L. Roman, Montoya, A. A. Tanaka, Martinez, A. D. C. Amador, Ayala, L. Y. Delgado, Zepeda, E. Monares, Granillo, J. Franco, Sanchez, J. Aguirre, Alejo, G. Camarena, Cabrera, A. Rugerio, Montenegro, A. Pedraza, Pham, T., Beduneau, G., Schortgen, F., Piquilloud, L., Zogheib, E., Jonas, M., Grelon, F., Runge, I., Terzi, N., Grangé, S., Barberet, G., Guitard, P. G., Frat, J. P., Constan, A., Chrétien, J. M., Mancebo, J., Mercat, A., Richard, J. C. M., Brochard, L., Soilemezi, E., Koco, E., Savvidou, S., Nouris, C., Matamis, D., Di Mussi, R., Spadaro, S., Volta, C. A., Mariani, M., Colaprico, A., Antonio, C., Bruno, F., Grasso, S., Rodriguez, A., Martín-Loeches, I., Díaz, E., Masclans, J. R., Gordo, F., Solé-Violán, J., Bodí, M., Avilés-Jurado, F. X., Trefler, S., Magret, M., Reyes, L. F., Marín-Corral, J., Yebenes, J. C., Esteban, A., Anzueto, A., Aliberti, S., Restrepo, M. I., Larsson, J. Skytte, Redfors, B., Ricksten, S. E., Haines, R., Powell-Tuck, J., Leonard, H., Ostermann, M., Berthelsen, R. E., Itenov, T. S., Perner, A., Jensen, J. U., Ibsen, M., Jensen, A. E. K., Bestle, M. H., Bucknall, T., Dixon, J., Boa, F., MacPhee, I., Philips, B. J., Doyle, J., Saadat, F., Samuels, T., Huddart, S., McCormick, B., DeBrunnar, R., Preece, J., Swart, M., Peden, C., Richardson, S., Forni, L., Kalfon, P., Baumstarck, K., Estagnasie, P., Geantot, M. A., Berric, A., Simon, G., Floccard, B., Signouret, T., Boucekine, M., Fromentin, M., Nyunga, M., Sossou, A., Venot, M., Robert, R., Follin, A., Renault, A., Garrouste, M., Collange, O., Levrat, Q., Villard, I., Thévenin, D., Pottecher, J., Patrigeon, R. G., Revel, N., Vigne, C., Mimoz, O., Auquier, P., Pawar, S., Jacques, T., Deshpande, K., Pusapati, R., Wood, B., Pulham, R. A., Wray, J., Brown, K., Pierce, C., Nadel, S., Ramnarayan, P., Azevedo, J. R., Montenegro, W. S., Rodrigues, D. P., Sousa, S. C., Araujo, V. F., Leitao, A. L., Prazeres, P. H., Mendonca, A. V., Paula, M. P., Das Neves, A., Loudet, C. I., Busico, M., Vazquez, D., Villalba, D., Lischinsky, A., Veronesi, M., Emmerich, M., Descotte, E., Juliarena, A., Bisso, M. Carboni, Grando, M., Tapia, A., Camargo, M., Ulla, D. Villani, Corzo, L., dos Santos, H. Placido, Ramos, A., Doglia, J. A., Estenssoro, E., Carbonara, M., Magnoni, S., Donald, C. L. Mac, Shimony, J. S., Conte, V., Triulzi, F., Stretti, F., Macrì, M., Snyder, A. Z., Stocchetti, N., Brody, D. L., Podlepich, V., Shimanskiy, V., Savin, I., Lapteva, K., Chumaev, A., Tjepkema-Cloostermans, M. C., Hofmeijer, J., Beishuizen, A., Hom, H., Blans, M. J., van Putten, M. J. A. M., Longhi, L., Frigeni, B., Curinga, M., Mingone, D., Beretta, S., Patruno, A., Gandini, L., Vargiolu, A., Ferri, F., Ceriani, R., Rottoli, M. R., Lorini, L., Citerio, G., Pifferi, S., Battistini, M., Cordolcini, V., Agarossi, A., Di Rosso, R., Ortolano, F., Stocchetti, N., Lourido, C. Mora, Cabrera, J. L. Santana, Santana, J. D. Martín, Alzola, L. Melián, del Rosario, C. García, Pérez, H. Rodríguez, Torrent, R. Lorenzo, Eslami, S., Dalhuisen, A., Fiks, T., Schultz, M. J., Hanna, A. Abu, Spronk, P. E., Wood, M., Maslove, D., Muscedere, J., Scott, S. H., Saha, T., Hamilton, A., Petsikas, D., Payne, D., Boyd, J. G., Puthucheary, Z. A., McNelly, A. S., Rawal, J., Connolly, B., McPhail, M. J., Sidhu, P., Rowlerson, A., Moxham, J., Harridge, S. D., Hart, N., Montgomery, H. E., Jovaisa, T., Thomas, B., Gupta, D., Wijayatilake, D. S., Shum, H. P., King, H. S., Chan, K. C., Tang, K. B., Yan, W. W., Arias, C. Castro, Latorre, J., De La Rica, A. Suárez, Garrido, E. Maseda, Feijoo, A. Montero, Gancedo, C. Hernández, Tofiño, A. López, Rodríguez, F. Gilsanz, Gemmell, L. K., Campbell, R., Doherty, P., MacKay, A., Singh, N., Vitaller, S., Nagib, H., Prieto, J., Del Arco, A., Zayas, B., Gomez, C., Tirumala, S., Pasha, S. A., Kumari, B. K., Martinez-Lopez, P., Puerto-Morlán, A., Nuevo-Ortega, P., Pujol, L. Martinez, Dolset, R. Algarte, González, B. Sánchez, Riera, S. Quintana, Álvarez, J. Trenado, Quintana, S., Martínez, L., Algarte, R., Sánchez, B., Trenado, J., Tomas, E., Brock, N., Viegas, E., Filipe, E., Cottle, D., Traynor, T., Martínez, M. V. Trasmonte, Márquez, M. Pérez, Gómez, L. Colino, Martínez, N. Arias, Muñoz, J. M. Milicua, Bellver, B. Quesada, Varea, M. Muñoz, Llorente, M. Á. Alcalá, Calvo, C. Pérez, Hillier, S. D., Faulds, M. C., Hendra, H., Lawrence, N., Maekawa, K., Hayakawa, M., Ono, Y., Kodate, A., Sadamoto, Y., Tominaga, N., Mizugaki, A., Murakami, H., Yoshida, T., Katabami, K., Wada, T., Sawamura, A., Gando, S., Silva, S., Kerhuel, L., Malagurski, B., Citerio, G., Chabanne, R., Laureys, S., Puybasset, L., Nobile, L., Pognuz, E. R., Rossetti, A. O., Verginella, F., Gaspard, N., Creteur, J., Ben-Hamouda, N., Oddo, M., Taccone, F. S., Ono, Y., Hayakawa, M., Iijima, H., Maekawa, K., Kodate, A., Sadamoto, Y., Mizugaki, A., Murakami, H., Katabami, K., Wada, T., Sawamura, A., Gando, S., Kodate, A., Katabami, K., Wada, T., Ono, Y., Maekawa, K., Hayakawa, M., Sawamura, A., Gando, S., Andersen, L. W., Raymond, T., Berg, R., Nadkarni, V., Grossestreuer, A., Kurth, T., Donnino, M., Krüger, A., Ostadal, P., Janotka, M., Vondrakova, D., Kongpolprom, N., Cholkraisuwat, J., Pekkarinen, P. T., Ristagno, G., Masson, S., Latini, R., Bendel, S., Ala-Kokko, T., Varpula, T., Vaahersalo, J., Hoppu, S., Tiainen, M., Mion, M. M., Plebani, M., Pettilä, V., Skrifvars, M.B., Son, Y., Kim, K. S., Suh, G. J., Kwon, W. Y., Ko, J. I., Park, M. J., Cavicchi, F. Zama, Iesu, E., Nobile, L., Vincent, J. L., Creteur, J., Taccone, F. S., Tanaka, H., Otani, N., Ode, S., Ishimatsu, S., Martínez, L., Algarte, R., Sánchez, B., Romero, I., Martínez, F., Quintana, S., Trenado, J., Vondrakova, D., Ostadal, P., Kruger, A., Janotka, M., Malek, F., Neuzil, P., Yeh, Y. C., Chen, Y. S., Wang, C. H., Huang, C. H., Chao, A., Lee, C. T., Lai, C. H., Chan, W. S., Cheng, Y. J., Sun, W. Z., Kaese, S., Horstmann, C., Lebiedz, P., Mourad, M., Gaudard, P., Eliet, J., Zeroual, N., Colson, P., Ostadal, P., Mlcek, M., Hrachovina, M., Kruger, A., Vondrakova, D., Janotka, M., Mates, M., Hala, P., Kittnar, O., Neuzil, P., Jacky, A., Rudiger, A., Spahn, D. R., Bettex, D. A., Kara, A., Akin, S., Dos reis Miranda, D., Struijs, A., Caliskan, K., van Thiel, R. J., Dubois, E. A., de Wilde, W., Zijlstra, F., Gommers, D., Ince, C., Marca, L., Xini, A., Mongkolpun, W., Cordeiro, C. P. R., Leite, R. T., Lheureux, O., Bader, A., Rincon, L., Santacruz, C., Preiser, J. C., Chao, A., Chao, A. S., Chen, Y. S., Kim, W., Ahn, C., Cho, Y., Lim, T. 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Agudo, León, J. P. Tirapu, Irazabal, J. M. Guergue, Pérez, A. González, Fernández, P. Alvarez, Amor, L. Lopéz, Albaiceta, G. Muñiz, Lesmes, S. P. Gómez, Rosario, L. E. De la Cruz, Hernández, A. Ansotegui, Sanz, E. Regidor, Sánchez, M. J. Gómez, Calvo, S. Aldunate, Herrera, A. N. García, Hualde, J. Barado, Pascual, O. Agudo, León, J. P. Tirapu, Corona, A., Ruffini, C., Spazzadeschi, A., Marrazzo, F., Gandola, A., Sciurti, R., Savi, C., Catena, E., Ke, M. W., Cheng, C. C., Huang, W. C., Chiang, C. H., Hung, W. T., Lin, K. C., Lin, S. C., Wann, S. R., Chiou, K. R., Tseng, C. J., Kang, P. L., Mar, G. Y., Liu, C. P., Bertini, P., De Sanctis, F., Guarracino, F., Bertini, P., Baldassarri, R., Guarracino, F., Buitinck, S. H., van der Voort, P. H. J., Oto, J., Nakataki, E., Tsunano, Y., Izawa, M., Tane, N., Onodera, M., Nishimura, M., Ghosh, S., Gupta, A., De Gasperi, A., Mazza, E., Limuti, R., Prosperi, M., Bissenova, N., Yergaliyeva, A., Talan, L., Yılmaz, G., Güven, G., Yoruk, F., Altıntas, N. D., Mukherjee, D. N., Agarwal, L. K., Mandal, K., Palomar, M., Balsera, B., Vallverdu, M., Martinez, M., Garcia, M., Castellana, D., Lopez, R., Barcenilla, F., Kaminsky, G. E., Carreño, R., Escribá, A., Fuentes, M., Gálvez, V., Del Olmo, R., Nieto, B., Vaquerizo, C., Alvarez, J., De la Torre, M. A., Torres, E., Bogossian, E., Nouer, S. Aranha, Salgado, D. Ribeiro, Brugger, S. Carvalho, Jiménez, G. Jiménez, Torner, M. Miralbés, Vidal, M. Vallverdú, Garrido, B. Balsera, Casals, X. Nuvials, Gaite, F. Barcenilla, Cabello, J. Trujillano, Martínez, M. Palomar, Doganci, M., Izdes, S., Besevli, S. Guzeldag, Alkan, A., Kayaaslan, B., Ramírez, C. Sánchez, Balcázar, L. Caipe, Santana, M. Cabrera, Viera, M. A. Hernández, Escalada, S. Hípola, Vázquez, C. F. Lübbe, Penichet, S. M. Marrero, Campelo, F. Artiles, López, M. A. De La Cal, Santana, P. Saavedra, Santana, S. Ruíz, Repessé, X., Artiguenave, M., Paktoris-Papine, S., Espinasse, F., Dinh, A., El Sayed, F., Charron, C., Géri, G., Vieillard-Baron, A., Marmanidou, K., Oikonomou, M., Nouris, C., Dimitroulakis, K., Soilemezi, E., Matamis, D., Ferré, A., Guillot, M., Teboul, J. L., Lichtenstein, D., Mézière, G., Richard, C., Monnet, X., Pham, T., Beduneau, G., Schortgen, F., Piquilloud, L., Zogheib, E., Jonas, M., Grelon, F., Runge, I., Terzi, N., Grangé, S., Barberet, G., Guitard, P. G., Frat, J. P., Constan, A., Chrétien, J. M., Mancebo, J., Mercat, A., Richard, J. C. M., Brochard, L., Prīdāne, S., Sabeļņikovs, O., Mojoli, F., Orlando, A., Bianchi, I., Torriglia, F., Bianzina, S., Pozzi, M., Iotti, G. A., Braschi, A., Beduneau, G., Pham, T., Schortgen, F., Piquilloud, L., Zogheib, E., Jonas, M., Grelon, F., Runge, I., Terzi, N., Grangé, S., Barberet, G., Guitard, P. G., Frat, J. P., Constan, A., Chrétien, J. M., Mancebo, J., Mercat, A., Richard, J. C. M., Brochard, L., Kondili, E., Psarologakis, C., Kokkini, S., Amargianitakis, V., Babalis, D., Chytas, A., Chouvarda, I., Vaporidi, K., Georgopoulos, D., Trapp, O., Kalenka, A., Mojoli, F., Orlando, A., Bianchi, I., Torriglia, F., Bianzina, S., Pozzi, M., Iotti, G. A., Braschi, A., Lozano, J. A. Benítez, Sánchez, P. Carmona, Francioni, J. E. Barrueco, Ferrón, F. Ruiz, Simón, J. M. Serrano, Spadaro, S., Karbing, D. S., Gioia, A., Moro, F., Corte, F. Dalla, Mauri, T., Volta, C. A., Rees, S. E., Petrova, M. V., Mohan, R., Butrov, A. V., Beeharry, S. D., Vatsik, M. V., Sakieva, F. I., Gobert, F., Yonis, H., Tapponnier, R., Fernandez, R., Labaune, M. A., Burle, J. F., Barbier, J., Vincent, B., Cleyet, M., Richard, J. C., Guérin, C., Shinotsuka, C. Righy, Creteur, J., Taccone, F. S., Törnblom, S., Nisula, S., Vaara, S., Poukkanen, M., Andersson, S., Pettilä, V., Pesonen, E., Xie, Z., Liao, X., Kang, Y., Zhang, J., Kubota, K., Egi, M., Mizobuchi, S., Hegazy, S., El-Keraie, A., El Sayed, E., El Hamid, M. Abd, Rodrigues, N. J., Pereira, M., Godinho, I., Gameiro, J., Neves, M., Gouveia, J., e Silva, Z. Costa, Lopes, J. A., Mckinlay, J., Kostalas, M., Kooner, G., Dudas, G., Horton, A., Kerr, C., Karanjia, N., Creagh-Brown, B., Forni, L., Yamazaki, A., Ganuza, M. Sanz, Molina, J. A. Martinez, Martinez, F. Hidalgo, Freile, M. T. Chiquito, Fernandez, N. Garcia, Travieso, P. Medrano, Bandert, A., Frithiof, R., Lipcsey, M., Smekal, D., Schlaepfer, P., Durovray, J. D., Plouhinec, V., Chiappa, C., Bellomo, R., Schneider, A. G., Mitchell, S., Durrant, J., Street, H., Dunthorne, E., Shears, J., Caballero, C. Hernandez, Hutchison, R., Schwarze, S., Ghabina, S., Thompson, E., Prowle, J. R., Kirwan, C. J., Gonzalez, C. A., Pinto, J. L., Orozco, V., Patiño, J. A., Garcia, P. K., Contreras, K. M., Rodriguez, P., Echeverri, J. E., GETGAG Working Group, JSEPTIC (Japanese Society of Education for Physicians and Trainees in Intensive Care) Clinical Trial Group, CAPCRI Study, for the ReVA Research Network and the PROVE Network Investigators, from the FROG ICU Investigators, The WIND study group, Plug Working Group, GETGAG/SEMICYUC, AKI Research Group, St George’s University of London, IPREA Study Group, FINNRESUSCI Study Group, PICS- HCPA: Programa Intrahospitalar de Combate à Sepse do Hospital de Clínicas de Porto Alegre, ENVIN-HELICS Study Group, ARIAM registry of adult cardiac surgery, The Rapid Diagnosis of Infections in the Critically Ill Team, Tokyo Womens Medical University, PLUG working group, PLUG Working Group, On behalf of Okayama Research Investigation Organizing Network (ORION)investigators, PS-ICU Group, Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study group, Student Research Committee - Shiraz University of Medical Sciences, ARIAM-ANDALUCIA, The WIND study group, PLUG Working Group, The WIND study group, PLUG Working Group, and Plug working group

Published
2016
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19. What's new in the quantification of causal effects from longitudinal cohort studies: a brief introduction to marginal structural models for intensivists

Author

Bailly, S., Pirracchio, R., and Timsit, J. F.

Subjects
Medical research -- Methods, Medicine, Experimental -- Methods, Antifungal agents -- Dosage and administration -- Testing, Critically ill -- Care and treatment, Critical care medicine -- Research, Health care industry
Abstract

Author(s): S. Bailly [sup.1] [sup.2] , R. Pirracchio [sup.3] [sup.4] , J. F. Timsit [sup.2] [sup.5] Author Affiliations: (1) grid.450307.5, U823, Grenoble Alpes University, , Rond-point de la Chantourne, 38700, [...]

Published
2016
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27. Effects of low-dose hydrocortisone and hydrocortisone plus fludrocortisone in adults with septic shock: A protocol for a systematic review and meta-analysis of individual participant data

Author

Annane, D, Pirracchio, R, Billot, L, Waschka, A, Chevret, S, Cohen, J, Finfer, S, Gordon, A, Hammond, N, Myburgh, J, Venkatesh, B, Delaney, A, Annane, D, Pirracchio, R, Billot, L, Waschka, A, Chevret, S, Cohen, J, Finfer, S, Gordon, A, Hammond, N, Myburgh, J, Venkatesh, B, and Delaney, A

Abstract

Introduction The benefits and risks of low-dose hydrocortisone in patients with septic shock have been investigated in numerous randomised controlled trials and trial-level meta-analyses. Yet, the routine use of this treatment remains controversial. To overcome the limitations of previous meta-analyses inherent to the use of aggregate data, we will perform an individual patient data meta-analysis (IPDMA) on the effect of hydrocortisone with or without fludrocortisone compared with placebo or usual care on 90-day mortality and other outcomes in patients with septic shock. Methods and analysis To assess the benefits and risks of hydrocortisone, with or without fludrocortisone for adults with septic shock, we will search major electronic databases from inception to September 2020 (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Latin American Caribbean Health Sciences Literature), complimented by a search for unpublished trials. The primary analysis will compare hydrocortisone with or without fludrocortisone to placebo or no treatment in adult patients with septic shock. Secondary analyses will compare hydrocortisone to placebo (or usual care), hydrocortisone plus fludrocortisone to placebo (or usual care), and hydrocortisone versus hydrocortisone plus fludrocortisone. The primary outcome will be all cause mortality at 90 days. We will conduct both one-stage IPDMA using mixed-effect models and machine learning with targeted maximum likelihood analyses. We will assess the risk of bias related to unshared data and related to the quality of individual trial. Ethics and dissemination This IPDMA will use existing data from completed randomised clinical trials and will comply with the ethical and regulatory requirements regarding data sharing for each of the component trials. The findings of this study will be submitted for publication in a peer-review journal with straightforward policy for open access.

Published
2020

45. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly

Author

Sprung, C, Artigas, A, Kesecioglu, J, Pezzi, A, Wiis, J, Pirracchio, R, Baras, M, Edbrooke, D, Pesenti, A, Bakker, J, Hargreaves, C, Gurman, G, Cohen, S, Lippert, A, Payen, D, Corbella, D, Iapichino, G, Sprung, CL, Edbrooke, DL, PESENTI, ANTONIO MARIA, Cohen, SL, Iapichino, G., Sprung, C, Artigas, A, Kesecioglu, J, Pezzi, A, Wiis, J, Pirracchio, R, Baras, M, Edbrooke, D, Pesenti, A, Bakker, J, Hargreaves, C, Gurman, G, Cohen, S, Lippert, A, Payen, D, Corbella, D, Iapichino, G, Sprung, CL, Edbrooke, DL, PESENTI, ANTONIO MARIA, Cohen, SL, and Iapichino, G.

Abstract

RATIONALE:: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:: To determine the effect of intensive care unit triage decisions on mortality and intensive care unit benefit, specifically for elderly patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with an explicit request for intensive care unit admission. INTERVENTIONS:: Admission or rejection to intensive care unit. MEASUREMENTS AND MAIN RESULTS:: Demographic, clinical, hospital, physiologic variables, and 28-day mortality were obtained on consecutive patients. There were 8,472 triages in 6,796 patients, 5,602 (82%) were accepted to the intensive care unit, 1,194 (18%) rejected; 3,795 (49%) were ≥65 yrs. Refusal rate increased with increasing patient age (18-44: 11%; 45-64: 15%; 65-74: 18%; 75-84: 23%; >84: 36%). Mortality was higher for older patients (18-44: 11%; 45-64: 21%; 65-74: 29%; 75-84: 37%; >84: 48%). Differences between mortalities of accepted vs. rejected patients, however, were greatest for older patients (18-44: 10.2% vs. 12.5%; 45-64: 21.2% vs. 22.3%; 65-74: 27.9% vs. 34.6%; 75-84: 35.5% vs. 40.4%; >84: 41.5% vs. 58.5%). Logistic regression showed a greater mortality reduction for accepted vs. rejected patients corrected for disease severity for elderly patients (age >65 [odds ratio 0.65, 95% confidence interval: 0.55-0.78, p < .0001]) than younger patients (age ≤65 [odds ratio 0.74, 95% confidence interval: 0.57-0.97, p = .01]). CONCLUSIONS:: Despite the fact that elderly patients have more intensive care unit rejections than younger patients and have a higher mortality when admitted, the mortality benefit appears greater for the elderly. Physicians should co

Published
2012

46. Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis

Author

Edbrooke, D, Minelli, C, Mills, G, Iapichino, G, Pezzi, A, Corbella, D, Jacobs, P, Lippert, A, Wiis, J, Pesenti, A, Patroniti, N, Pirracchio, R, Payen, D, Gurman, G, Bakker, J, Kesecioglu, J, Hargreaves, C, Cohen, S, Baras, M, Artigas, A, Sprung, C, Edbrooke, DL, Mills, GH, PESENTI, ANTONIO MARIA, PATRONITI, NICOLO' ANTONINO, Cohen, SL, Sprung, CL, Edbrooke, D, Minelli, C, Mills, G, Iapichino, G, Pezzi, A, Corbella, D, Jacobs, P, Lippert, A, Wiis, J, Pesenti, A, Patroniti, N, Pirracchio, R, Payen, D, Gurman, G, Bakker, J, Kesecioglu, J, Hargreaves, C, Cohen, S, Baras, M, Artigas, A, Sprung, C, Edbrooke, DL, Mills, GH, PESENTI, ANTONIO MARIA, PATRONITI, NICOLO' ANTONINO, Cohen, SL, and Sprung, CL

Abstract

Introduction: Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case. Randomised studies of the effectiveness of intensive care are difficult to justify on ethical grounds; therefore, this observational study examined the cost effectiveness of ICU admission by comparing patients who were accepted into ICU after ICU triage to those who were not accepted, while attempting to adjust such comparison for confounding factors.Methods: This multi-centre observational cohort study involved 11 hospitals in 7 EU countries and was designed to assess the cost effectiveness of admission to intensive care after ICU triage. A total of 7,659 consecutive patients referred to the intensive care unit (ICU) were divided into those accepted for admission and those not accepted. The two groups were compared in terms of cost and mortality using multilevel regression models to account for differences across centres, and after adjusting for age, Karnofsky score and indication for ICU admission. The analyses were also stratified by categories of Simplified Acute Physiology Score (SAPS) II predicted mortality (< 5%, 5% to 40% and >40%). Cost effectiveness was evaluated as cost per life saved and cost per life-year saved.Results: Admission to ICU produced a relative reduction in mortality risk, expressed as odds ratio, of 0.70 (0.52 to 0.94) at 28 days. When stratified by predicted mortality, the odds ratio was 1.49 (0.79 to 2.81), 0.7 (0.51 to 0.97) and 0.55 (0.37 to 0.83) for <5%, 5% to 40% and >40% predicted mortality, respectively. Average cost per life saved for all patients was $103,771 (€82,358) and cost per life-year saved was $7,065 (€5,607). The

Published
2011

47. Fluid resuscitation does not improve renal oxygenation during hemorrhagic shock in rats

Author

Legrand, M. (Matthieu), Mik, E.G. (Egbert), Balestra, G. (Gianmarco), Lutter, R. (Rene), Pirracchio, R. (Romain), Payen, D. (Didier), Ince, C. (Can), Legrand, M. (Matthieu), Mik, E.G. (Egbert), Balestra, G. (Gianmarco), Lutter, R. (Rene), Pirracchio, R. (Romain), Payen, D. (Didier), and Ince, C. (Can)

Abstract

Background: The resuscitation strategy for hemorrhagic shock remains controversial, with the kidney being especially prone to hypoxia. Methods: The authors used a three-phase hemorrhagic shock model to investigate the effects of fluid resuscitation on renal oxygenation. After a 1-h shock phase, rats were randomized into four groups to receive either normal saline or hypertonic saline targeting a mean arterial pressure (MAP) of either 40 or 80 mmHg. After such resuscitation, rats were transfused with the shed blood. Renal macro-and microcirculation were monitored with cortical and outer-medullary microvascular oxygen pressure, renal oxygen delivery, and renal oxygen consumption measured using oxygen-dependent quenching of phosphorescence. Results: Hemorrhagic shock was characterized by a drop of aortic blood flow, MAP, renal blood flow, renal oxygen delivery, renal oxygen consumption, and renal microvascular PO2. During the fluid resuscitation phase, normal saline targeting a MAP = 80 mmHg was the sole strategy able to restore aortic blood flow, renal blood flow, and renal oxygen consumption, although without improving renal oxygen delivery. However, none of the strategies using either normal saline or hypertonic saline or targeting a high MAP could restore the renal microvascular Po2. Blood transfusion increased microvascular Po2 but was unable to totally restore renal microvascular oxygenation to baseline values. Conclusions: This experimental rat study shows that (1) high MAP-directed fluid resuscitation (80 mmHg) does not lead to higher renal microvascular Po2 compared with fluid resuscitation targeted to MAP (40 mmHg); (2) hypertonic saline is not superior to normal saline regarding renal oxygenation; and (3) decreased renal oxygenation persists after blood transfusion.

Published
2010
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49. 305: Early results from an emergency center dedicated for acute aortic syndromes with round-the-clock access

Author

Achouh, Paul, primary, Alsac, Jean Marc, additional, Pirracchio, R., additional, Abi Akar, R., additional, Lagrange, A., additional, Bellenfant, F., additional, Hagege, Albert, additional, Chollet, Bernard, additional, Journois, D., additional, Messas, Emmanuel, additional, Saffran, Denis, additional, and Fabiani, Jean Noel, additional

Published
2013
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