Rationale: Whether extubation immediately after a successful spontaneous breathing trial is associated with clinical benefits in adult patients with acute brain injury is unknown.
Objectives: We sought to estimate the association between a prompt extubation attempt and ventilator-free days among adult patients with acute brain injury.
Methods: We performed an emulation of a previously designed randomized controlled trial using data from the Toronto Intensive Care Observational Registry in 8 intensive care units in Toronto, Ontario. We included mechanically ventilated adult patients with acute brain injury who had a first successful spontaneous breathing trial. Our main exposure was prompt extubation (i.e., on the same calendar day following the first successful spontaneous breathing trial). The primary outcome was ventilator-free days up to 28 days. We used inverse probability of treatment weighting to adjust for confounding and reported treatment effects using incidence rate ratios (IRR) and 95% confidence intervals (CI).
Measurements and main results: 1,406 patients between April 2014 through March 2023 met inclusion criteria. The main reasons for admission were traumatic brain injury (40%), stroke (ischemic or hemorrhagic; 20%), seizures (11%), and subarachnoid hemorrhage (9%). Over half (57%) of patients underwent prompt extubation following their first successful spontaneous breathing trial. Prompt extubation was associated with more ventilator-free days (IRR: 1.24; 95% CI: 1.19 - 1.29) when compared to no prompt extubation.
Conclusions: Prompt extubation following a first successful spontaneous breathing trial was associated with more ventilator-free days (up to 28 days) among adults with acute brain injury receiving invasive mechanical ventilation.
Keywords: acute brain injury; extubation; spontaneous breathing trial; ventilator free days.