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

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.; Adrian Gasca, G.; Arellano, A.; Tariq Reza, S.; Hossain, M. M.; Papadas, C.; Chantziara, V.; Sklavou, C.; Hourmant, Y.; Grillot, N.; Van Steenkiste, J.; Van Der Jagt, M.; 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.; Tariq Reza, S.; Atef Azab, M.; Catherine Digitale, J.; Fong, N.; Campos Cerda, R.; De La Torre Peredo, N.; Pirracchio, R.; David Stevens, R.

doi:10.1097/CCM.0000000000006283

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 in patients with low scores is not excluded.

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 / 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.; Adrian Gasca, G.; Arellano, A.; Tariq Reza, S.; Hossain, M. M.; Papadas, C.; Chantziara, V.; Sklavou, C.; Hourmant, Y.; Grillot, N.; Van Steenkiste, J.; Van Der Jagt, M.; 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.; Tariq Reza, S.; Atef Azab, M.; Catherine Digitale, J.; Fong, N.; Campos Cerda, R.; De La Torre Peredo, N.; Pirracchio, R.; David Stevens, R.. - In: CRITICAL CARE MEDICINE. - ISSN 1530-0293. - 52:8(2024), pp. 1258-1263. [10.1097/CCM.0000000000006283]