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Background <p>Invasive mechanical ventilation can present complex challenges for patients with acute brain injury (ABI) in middle-income countries (MICs). We characterized the impact of country income level on weaning strategies and outcomes in patients with ABI.</p> Methods <p>A secondary analysis was performed on a registry of critically ill patients with ABI admitted to 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Patients were classified as high-income country (HIC) or MIC. The primary outcome was ICU mortality. Secondary outcomes were days to first extubation, tracheostomy, extubation failure, ICU length of stay, and hospital mortality. Multivariable analyses were adjusted for clinically preselected covariates such as age, sex, body mass index, neurological severity, comorbidities, and ICU management. Extubation and tracheostomy outcomes were also adjusted for arterial blood gas values and ventilatory settings.</p> Results <p>Of 1512 patients (median age = 54&#xa0;years, 66% male), 1170 (77%) were from HICs, and 342 (23%) were from MICs. Median age was significantly lower in MICs [35 (range 26–52) vs. 58 (range 45–68) years in HICs]. Neurosurgical procedures (47.7% vs. 38.2%) and decompressive craniectomy (30.7% vs. 15.9%) were more common in MICs, whereas intracranial pressure monitoring (12.0% vs. 51.5%) and external ventricular drain (7.6% vs. 35.6%) were less common. Compared with HICs, patients from MICs had 2.27 times the odds of ICU mortality [<i>p</i> = 0.009, 95% confidence interval (CI) 1.22–4.21]. Frequency of extubation failure was lower in MICs but not significant after adjustment. Patients from MICs had 3.38 times the odds of tracheostomy (<i>p</i> ≤ 0.001, 95% CI 2.28–5.01), 5.59&#xa0;days shorter mean ICU stay (<i>p</i> &lt; 0.001, 95% CI − 7.82 to − 3.36), and 1.96 times the odds of hospital mortality (<i>p</i> = 0.011, 95% CI 1.17–3.30).</p> Conclusions <p>In an international registry of patients with ABI requiring invasive mechanical ventilation, MICs had higher odds of ICU mortality, tracheostomy placement, and hospital mortality compared with HICs, which may be due to difference in neurocritical care resources and management.</p>

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Impact of Country Income Level on Outcomes in Patients with Acute Brain Injury Requiring Invasive Mechanical Ventilation: A Secondary Analysis of the ENIO Study

  • 期刊论文

  • 发表日期：

    2025年1月7日

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

摘要

Background

Invasive mechanical ventilation can present complex challenges for patients with acute brain injury (ABI) in middle-income countries (MICs). We characterized the impact of country income level on weaning strategies and outcomes in patients with ABI.

Methods

A secondary analysis was performed on a registry of critically ill patients with ABI admitted to 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Patients were classified as high-income country (HIC) or MIC. The primary outcome was ICU mortality. Secondary outcomes were days to first extubation, tracheostomy, extubation failure, ICU length of stay, and hospital mortality. Multivariable analyses were adjusted for clinically preselected covariates such as age, sex, body mass index, neurological severity, comorbidities, and ICU management. Extubation and tracheostomy outcomes were also adjusted for arterial blood gas values and ventilatory settings.

Results

Of 1512 patients (median age = 54 years, 66% male), 1170 (77%) were from HICs, and 342 (23%) were from MICs. Median age was significantly lower in MICs [35 (range 26–52) vs. 58 (range 45–68) years in HICs]. Neurosurgical procedures (47.7% vs. 38.2%) and decompressive craniectomy (30.7% vs. 15.9%) were more common in MICs, whereas intracranial pressure monitoring (12.0% vs. 51.5%) and external ventricular drain (7.6% vs. 35.6%) were less common. Compared with HICs, patients from MICs had 2.27 times the odds of ICU mortality [p = 0.009, 95% confidence interval (CI) 1.22–4.21]. Frequency of extubation failure was lower in MICs but not significant after adjustment. Patients from MICs had 3.38 times the odds of tracheostomy (p ≤ 0.001, 95% CI 2.28–5.01), 5.59 days shorter mean ICU stay (p < 0.001, 95% CI − 7.82 to − 3.36), and 1.96 times the odds of hospital mortality (p = 0.011, 95% CI 1.17–3.30).

Conclusions

In an international registry of patients with ABI requiring invasive mechanical ventilation, MICs had higher odds of ICU mortality, tracheostomy placement, and hospital mortality compared with HICs, which may be due to difference in neurocritical care resources and management.