Ventilator weaning and extubation in patients with primary brain injury: Recent evidence and ongoing uncertainties

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High quality studies to guide ventilator weaning and extubation in primary brain-injured patients are scarce. Liberation from invasive ventilation may be delayed due to low level of consciousness, diminished airway protective reflexes, or uncertain patient trajectory. As a result, extubation failure necessitating reintubation is common in this population. The present lecture will review evidence from recent observational studies and randomized trials related to ventilator weaning and extubation readiness in brain-injured patients, with the goal of providing data to guide liberation efforts. Ongoing knowledge gaps will be discussed. Relevant epidemiologic principles, statistical methods, and basic principles in causal inference will also be reviewed to enhance the interpretation of observational studies in this clinical domain.

Biography of speaker: Shaurya Taran, MD, FRCPC, PhD (student) is a critical care physician at Toronto Western Hospital, University Health Network in Toronto, ON. He received his fellowship in medical-surgical critical care at the University of Toronto and his neurocritical fellowship at Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard University, Boston, MA. He is currently pursuing a PhD in Clinical Epidemiology through the Institute of Health Policy, Management, and Evaluation at the University of Toronto. His ongoing program of research relates to mechanical ventilation in patients with primary brain injury, and he receives funding from the Canadian Institute of Health Research to study various aspects of ventilator weaning and extubation readiness in this population.