Early neurological wake‐up test in intubated patients with traumatic brain injury
Dublin Core
Title
Early neurological wake‐up test in intubated patients with traumatic brain injury
Subject
Traumatic brain injury, Mechanical ventilation, Sedation, Neurological wake-up test, Prognosis
Description
Abstract
Background Daily wake-up has been implemented widely in intensive care units (ICU) and could improve
the patients’ prognosis. However, little is known about the benefit of early neurological wake-up test (ENWT)
in patients with acute traumatic brain injury (TBI). We aimed to investigate the role of ENWT as a clinical monitoring
tool for TBI and its association with prognosis.
Methods This is an observational retrospective study included intubated and continuously sedated TBI in ICU, and all
data were extracted from three tertiary hospitals from China. The main exposure of interest was ENWT, defined as ces-
sation of sedation within 24 h after admission. The primary outcome was 28-day mortality. Propensity score matching
(PSM) was performed at a 1:1 ratio. Multivariable analyses were further used to adjust for residual confounders.
Results The pre-matched and propensity score-matched cohorts included 1386 and 704 patients, respectively.
In the PSM analysis, 28-day mortality was 24.7% (87/352) in the ENWT group and 37.2% (131/352) in the control
group. ENWT was associated with lower 28-day mortality (hazard ratio [HR], 0.57; 95% CI, 0.44–0.76; P<0.001). ENWT
was also associated with lower in-hospital mortality (odds ratio [OR], 0.54; 95% CI, 0.38–0.77; P=0.001), and higher
discharge-home rate (OR, 1.83; 95% CI, 1.19–2.83; P=0.006). A sensitivity analysis using the entire cohort also dem-
onstrated lower 28-day mortality (HR, 0.58; 95% CI, 0.44–0.75; P<0.001). However, it should be noted that ENWT
was related to a higher rate of delirium during ICU stay (OR, 1.66; 95% CI, 1.21–2.26; P=0.001). Further analysis demon-
strated that tracheostomy during ICU stay led to a significant difference in 28-day mortality.
Conclusion ENWT was associated with a lower risk-adjusted 28-day mortality in acute TBI patients. A higher rate
of tracheostomy may partly contribute to this relationship.
Keywords Traumatic brain injury, Mechanical ventilation, Sedation, Neurological wake-up test, Prognosis
Background Daily wake-up has been implemented widely in intensive care units (ICU) and could improve
the patients’ prognosis. However, little is known about the benefit of early neurological wake-up test (ENWT)
in patients with acute traumatic brain injury (TBI). We aimed to investigate the role of ENWT as a clinical monitoring
tool for TBI and its association with prognosis.
Methods This is an observational retrospective study included intubated and continuously sedated TBI in ICU, and all
data were extracted from three tertiary hospitals from China. The main exposure of interest was ENWT, defined as ces-
sation of sedation within 24 h after admission. The primary outcome was 28-day mortality. Propensity score matching
(PSM) was performed at a 1:1 ratio. Multivariable analyses were further used to adjust for residual confounders.
Results The pre-matched and propensity score-matched cohorts included 1386 and 704 patients, respectively.
In the PSM analysis, 28-day mortality was 24.7% (87/352) in the ENWT group and 37.2% (131/352) in the control
group. ENWT was associated with lower 28-day mortality (hazard ratio [HR], 0.57; 95% CI, 0.44–0.76; P<0.001). ENWT
was also associated with lower in-hospital mortality (odds ratio [OR], 0.54; 95% CI, 0.38–0.77; P=0.001), and higher
discharge-home rate (OR, 1.83; 95% CI, 1.19–2.83; P=0.006). A sensitivity analysis using the entire cohort also dem-
onstrated lower 28-day mortality (HR, 0.58; 95% CI, 0.44–0.75; P<0.001). However, it should be noted that ENWT
was related to a higher rate of delirium during ICU stay (OR, 1.66; 95% CI, 1.21–2.26; P=0.001). Further analysis demon-
strated that tracheostomy during ICU stay led to a significant difference in 28-day mortality.
Conclusion ENWT was associated with a lower risk-adjusted 28-day mortality in acute TBI patients. A higher rate
of tracheostomy may partly contribute to this relationship.
Keywords Traumatic brain injury, Mechanical ventilation, Sedation, Neurological wake-up test, Prognosis
Creator
Meng Jiang1*†, Chang‐li Li2†, Xiao‐peng Wu3†, Xing‐chen Lin1
, Yuan‐run Zhu4
, Li‐gang Xu5 and Xiao‐feng Yang1*
, Yuan‐run Zhu4
, Li‐gang Xu5 and Xiao‐feng Yang1*
Source
https://doi.org/10.1186/s12245-025-00867-7
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Meng Jiang1*†, Chang‐li Li2†, Xiao‐peng Wu3†, Xing‐chen Lin1
, Yuan‐run Zhu4
, Li‐gang Xu5 and Xiao‐feng Yang1*, “Early neurological wake‐up test in intubated patients with traumatic brain injury,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12737.