@article{ref1,
title="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",
journal="Critical care medicine",
year="2024",
author="Taran, Shaurya and Perrot, Bastien and Angriman, Federico and Cinotti, Raphael",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="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. <br><br>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). <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0090-3493",
doi="10.1097/CCM.0000000000006283",
url="http://dx.doi.org/10.1097/CCM.0000000000006283"
}