Evidence map›Paper›PMID 41792523›Full record

Observational studyNeurocritical care2026

Utilization of Neuromuscular Blocking Agents in Acute Brain Injury and Associations with Outcomes: A Post Hoc Analysis of the ENIO Study.

Andrea Berardino, Fabio Gallo, Denise Battaglini, Raphael Cinotti, Karim Asehnoune, Patricia R M Rocco, Fabio Silvio Taccone, Nicolo' Patroniti, Marcus J Schultz, Andrea Barbanera and 7 more

Erratum issued Registry-linked trialAbstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT03400904 (Gestion du Sevrage de la Ventilation mécanique du Patient neurolésé en réanimation et Association Avec le Devenir. Etude Observationnelle Multi-centrique Internationale. Extubation Strategies in Neuro-Intensive Care Unit Patients and Associations With Outcome. The International Observational ENIO Study.), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03400904 completednot on this map

Gestion du Sevrage de la Ventilation mécanique du Patient neurolésé en réanimation et Association Avec le Devenir. Etude Observationnelle Multi-centrique Internationale. Extubation Strategies in Neuro-Intensive Care Unit Patients and Associations With Outcome. The International Observational ENIO Study.

TypeobservationalSponsorNantes University HospitalRan2018 to 2021Enrolled1,750ConditionsBrain InjuriesArmsPatients with brain injury and mechanical ventilation exposed to extubation/tracheostomy
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

Andrea BerardinoDepartment of Surgical Science and Integrated Diagnostic, University of Genova, Genoa, Italy.
Fabio GalloDepartment of Surgical Science and Integrated Diagnostic, University of Genova, Genoa, Italy.
Denise BattagliniDepartment of Surgical Science and Integrated Diagnostic, University of Genova, Genoa, Italy.
Raphael CinottiDepartment of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, 44000, Nantes, France.
Karim AsehnouneUMR 1246 SPHERE "MethodS in Patients-Centered Outcomes and Health Research", University of Nantes, University of Tours, INSERM, IRS2 22 Boulevard Benoni Goulin, 44200, Nantes, France.
Patricia R M RoccoLaboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, 373, Brazil.
Fabio Silvio TacconeDepartment of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
Nicolo' PatronitiDepartment of Surgical Science and Integrated Diagnostic, University of Genova, Genoa, Italy.
Marcus J SchultzDepartment of Anaesthesiology, Rescue- and Pain Medicine, Antonal Hospital St. Gallen, HOCH Health Ostschweiz, St. Gallen, Switzerland.
Andrea BarbaneraDepartment of Neurosurgery, AOU Santi Antonio, Biagio, Cesare, Arrigo, Alessandria, Italy.
Alessandro BertuccioDepartment of Neurosurgery, AOU Santi Antonio, Biagio, Cesare, Arrigo, Alessandria, Italy.
Luca MontagnaniIRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Pietro FiaschiDepartment of Neurosurgery, IRCCS Policlinico San Martino, Genoa, Italy.
Gianluigi ZonaDepartment of Neurosurgery, IRCCS Policlinico San Martino, Genoa, Italy.
Sarah WahlsterDepartments of Neurology, Neurosurgery, and Anesthesiology, University of Washington, Seattle, USA. wahlster@uw.edu.ORCID 0000-0002-1744-1166
Chiara RobbaDepartment of Surgical Science and Integrated Diagnostic, University of Genova, Genoa, Italy.
ENIO collaborators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNeuromuscular blocking agents (NMBA) have been used in mechanically ventilated patients with moderate-to-severe acute respiratory distress syndrome (ARDS), in cases of clinically significant ventilator dyssynchrony, and in patients with elevated intracranial pressure (ICP). However, practice patterns around NMBA utilization and their impact on outcomes in acute brain injury (ABI) remain insufficiently explored.

methodsThis study carried out a post hoc analysis of a multicenter, prospective observational study (NCT03400904) including adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required invasive mechanical ventilation (IMV) ≥ 24 h. Patients who received NMBA during their first week of ICU stay were propensity matched to those who did not.

resultsPropensity score matching was performed in 1482 patients; among the matched cohort (n = 258), 33.3% (n = 86) received NMBA. NMBA utilization varied from 0% to 59.3% across countries. Multivariable regressions demonstrated associations between NMBA use and utilization of intraparenchymal ICP monitoring (odds ratio, OR 2.06; 95% confidence interval, CI 1.16-3.76), extraventricular drain placement (OR 2.18; 95% CI 1.18-4.05), higher PaCO

conclusionsNMBA utilization varied widely, highlighting the need for more evidence to guide clinical practice. NMBA were most commonly used in patients with ICP monitoring or moderate-to-severe ARDS; associations with outcomes warrant further exploration in randomized controlled trials.

Indexed as

Brain InjuriesNeuromuscular Blocking AgentsOutcome Assessment, Health CareRespiration, ArtificialRespiratory Distress SyndromeAdultAgedBrain Injuries, TraumaticFemaleHumansMaleMiddle AgedProspective StudiesNeuromuscular Blocking AgentsAcute brain injuryAcute respiratory distress syndromeMechanical ventilationNeuromuscular blocking agentsStrokeTraumatic brain injury

Identifiers

PMID41792523

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.