Timing of Extubation in Adult Patients with Acute Brain Injury.

Area of Science:

• Critical Care Medicine
• Neurology
• Respiratory Therapy

Background:

• The clinical benefits of prompt extubation following a successful spontaneous breathing trial (SBT) in adult patients with acute brain injury (ABI) remain unclear.
• Mechanical ventilation in ABI patients requires careful management to minimize complications and optimize recovery.

Purpose of the Study:

• To estimate the association between prompt extubation and ventilator-free days (VFDs) in adult patients with ABI after a successful SBT.
• To investigate the impact of early extubation on reducing the duration of mechanical ventilation.

Main Methods:

• Emulation of a randomized controlled trial using data from the Toronto Intensive Care Observational Registry (2014-2023).
• Inclusion of adult patients with ABI who completed their first successful SBT.
• Exposure defined as prompt extubation (same calendar day as SBT); primary outcome was VFDs up to 28 days, analyzed using inverse probability of treatment weighting.

Main Results:

• 1,406 patients met inclusion criteria, with traumatic brain injury and stroke being common admission reasons.
• 57% of patients underwent prompt extubation after their first successful SBT.
• Prompt extubation was significantly associated with increased VFDs (IRR, 1.24; 95% CI, 1.19-1.29).

Conclusions:

• Prompt extubation following a successful SBT is associated with a significant increase in ventilator-free days in adult patients with ABI.
• These findings suggest that early extubation may be a beneficial strategy for patients with acute brain injury on mechanical ventilation.
• The study protocol was registered under NCT04291235.