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

IF 3.1 3区医学 Q2 CLINICAL NEUROLOGY Neurocritical Care Pub Date : 2025-01-07 DOI:10.1007/s12028-024-02198-6

Shi Nan Feng, Camilo Diaz-Cruz, Raphael Cinotti, Karim Asehnoune, Marcus J Schultz, Gentle S Shrestha, Paula R Sanches, Chiara Robba, Sung-Min Cho

{"title":"Impact of Country Income Level on Outcomes in Patients with Acute Brain Injury Requiring Invasive Mechanical Ventilation: A Secondary Analysis of the ENIO Study.","authors":"Shi Nan Feng, Camilo Diaz-Cruz, Raphael Cinotti, Karim Asehnoune, Marcus J Schultz, Gentle S Shrestha, Paula R Sanches, Chiara Robba, Sung-Min Cho","doi":"10.1007/s12028-024-02198-6","DOIUrl":null,"url":null,"abstract":"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.","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurocritical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12028-024-02198-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

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.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

国家收入水平对需要有创机械通气的急性脑损伤患者预后的影响：ENIO研究的二次分析

背景：在中等收入国家（MICs），有创机械通气对急性脑损伤（ABI）患者提出了复杂的挑战。我们描述了国家收入水平对ABI患者断奶策略和结局的影响。方法：对2018年至2020年在18个国家的73个重症监护病房（icu）入住的ABI危重患者进行了二次分析。患者分为高收入国家（HIC）和中等收入国家（MIC）。主要终点是ICU死亡率。次要结局是第一次拔管的天数、气管切开术、拔管失败、ICU住院时间和住院死亡率。对临床预选协变量（如年龄、性别、体重指数、神经系统严重程度、合并症和ICU管理）进行多变量分析调整。拔管和气管切开术的结果也根据动脉血气值和通气设置进行调整。结果：1512例患者（中位年龄54岁，男性66%）中，1170例（77%）来自hic， 342例（23%）来自mic。中等收入国家的中位年龄明显低于高收入国家[35（26-52岁），而高收入国家为58（45-68岁）]。神经外科手术（47.7%对38.2%）和减压颅切除术（30.7%对15.9%）在MICs中更为常见，而颅内压监测（12.0%对51.5%）和外脑室引流（7.6%对35.6%）则不太常见。与高收入人群相比，中等收入人群在ICU的死亡率是高收入人群的2.27倍[p = 0.009, 95%可信区间（CI） 1.22-4.21]。mic组拔管失败的频率较低，但调整后无显著性差异。来自中等收入人群的患者气管切开术的几率为3.38倍（p≤0.001,95% CI 2.28-5.01），平均ICU住院时间缩短5.59天(p结论：在需要有创机械通气的ABI患者的国际登记中，与高收入人群相比，中等收入人群在ICU死亡率、气管切开术位置和住院死亡率方面的几率更高，这可能是由于神经危重症护理资源和管理的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.