Extubation Strategies in Neuro-Intensive Care Unit Patients and Associations With Outcome.
Extubation Strategies in Neuro-Intensive Care Unit Patients and Associations With Outcome.
Rationale Prolonged mechanical ventilation (MV) is common in patients with severe Brain
 Injury (BI). Guidelines for the management of extubation are largely lacking for patients
 with BI, and the role of tracheostomy is highly uncertain. More important, data on practice
 of management of extubation is yet underreported, as is the use of tracheotomy in this
 specific subset of critical care patients.

 Objective The objective of this prospective observational study is to describe the management
 of extubation and tracheostomy in intensive care unit (ICU) patients with BI. The aim is to
 describe the incidence of extubation failure and the rate of tracheostomy.

 Study design The "Extubation strategies in Neuro-Intensive care unit patients, and
 associations with Outcomes (ENIO)" is an observational multicentre international cohort
 study.

 Study population The investigators will include patients undergoing BI, with an initial
 Glasgow Coma Score ≤ 12 and with a delivered duration of mechanical ventilation (MV) ≥ 24
 hours at ICU admission. The inclusion period will last 6 months in total, and each centre is
 expected to include at least 24 patients during this period. With over 60 ICUs participating
 worldwide, we expect to include 1500 patients.

 Main parameters Parameters to be collected include: general neurological management,
 ventilatory management, general ICU complications, specific data on extubation and
 tracheostomy, general in-ICU outcomes and in-hospital mortality.

 Nature and extent of the burden and risks associated with participation Because of the
 observational design of the study using routinely collected data, there is no additional
 burden for the patient. Collection of data from ICU charts and/or (written or electronic)
 medical records systems bears no risk to the patients.
Inclusion Criteria:

 -  Age ≥ 18 years' old

 -  Patients admitted in a ICU for a central neurological pathology, listed as follows,
 with estimated or clinically evaluated Glasgow Coma Score ≤12 before endo-tracheal
 intubation, with anomaly on brain CT-scan and requiring effective invasive mechanical
 ventilation ≥ 24 hours are eligible to the study:

 -  Traumatic Brain Injury

 -  Aneurysmal Subarachnoid haemorrhage

 -  Intra-Cranial Haemorrhage

 -  Ischemic Stroke

 -  Central Nervous System Infection (Abscess, Empyema, Meningitides, Encephalitis…)

 -  Brain Tumour

 -  Patient with an attempt of extubation and/or performance of a tracheostomy

 Exclusion Criteria:

 -  Patients < 18 years' old

 -  Patients with ongoing pregnancy

 -  Patients with spine cord injury above T4

 -  Resuscitated cardiac arrest

 -  Withdrawal of Life-Sustaining Treatment (WLST) in the first 24 hours