Extubation strategies in neuro-intensive care unit patients and associations with outcomes: the ENIO multicentre international observational study.

Cinotti, Raphaël; Pelosi, Paolo; Schultz, Marcus J; Aikaterini, Ioakeimidou; Alvarez, Pablo; Badenes, Rafael; Mc Credie, Victoria; Elbuzidi, Abdurrahmaan Suei; Elhadi, Muhammed; Godoy, Daniel Agustin; Gurjar, Mohan; Haenggi, Matthias; Kaye, Callum; Mijangos-Méndez, Julio Cesar; Piagnerelli, Michael; Piracchio, Romain; Reza, Syed Tariq; Stevens, Robert D; Yoshitoyo, Ueno and Asehnoune, Karim (2020). Extubation strategies in neuro-intensive care unit patients and associations with outcomes: the ENIO multicentre international observational study. Annals of translational medicine, 8(7), p. 503. AME Publishing Company 10.21037/atm.2020.03.160

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Prolonged invasive ventilation is common in patients with severe brain injury. Information on optimal management of extubation and on the use of tracheostomy in these patients is scarce. International guidelines regarding the ventilator liberation and tracheostomy are currently lacking.


The aim of 'Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes' (ENIO) study is to describe current management of weaning from invasive ventilation, focusing on decisions on timing of tracheal extubation and tracheostomy in intensive care unit (ICU) patients with brain injury. We conducted a prospective, international, multi-centre observational study enrolling patients with various types of brain injury, including trauma, stroke, and subarachnoid haemorrhage, with an initial Glasgow Coma Score equal or less than 12, and a duration of invasive ventilation longer than 24 hours from ICU admission. ENIO is expected to include at least 1,500 patients worldwide. The primary endpoint of the ENIO study is extubation success in the 48 hours following endotracheal tube removal. The primary objective is to validate a score predictive of extubation success. To accomplish this, the study population will be randomly divided to a development cohort (2/3 of the included patients) and a validation cohort (the remaining 1/3). Secondary objectives are: to determine the incidence of extubation success rate according to various time-frames (within 96 hours, >96 hours after extubation); to validate (existing) prediction scores for successful extubation according to various time-frames and definitions (i.e., tracheostomy as extubation failure); and to describe the current practices of extubation and tracheostomy, and their associations.


ENIO will be the largest prospective observational study of ventilator liberation and tracheostomy practices in patients with severe brain injury undergoing invasive mechanical ventilation, providing a validated predictive score of successful extubation.

Trial registration

The ENIO study is registered in the Clinical Trials database: NCT03400904.

Item Type:

Journal Article (Further Contribution)


04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Hänggi, Matthias


600 Technology > 610 Medicine & health




AME Publishing Company




Mirella Aeberhard

Date Deposited:

10 Jun 2020 17:14

Last Modified:

05 Dec 2022 15:38

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Weaning brain injury extubation intra-cranial haemorrhage subarachnoid haemorrhage tracheostomy traumatic brain injury ventilator liberation





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