Extubation of patients with a gunshot penetrating head wound at the advanced stages of medical evacuation
N. V. Ermokhina,
G. G. Bulyshchenko,
A. V. Strelnikov,
A. A. Golovanov,
L. V. Ermokhina,
V. V. Stets,
J. M. Isaev,
V. K. Kisten,
A. I. Gaivoronskiy,
D. V. Svistov https://doi.org/10.24884/2078-5658-2025-22-5-60-69
Abstract
The objective was to evaluate the safety of early extubation of patients with gunshot wounds to the head at the advanced stages of medical evacuation.
Materials and methods. A single-center prospective cohort study of 43 wounded with gunshot wounds to the head, operated on at the stage of reduced specialized neurosurgical care (II+ level) in the period from April to June 2024, was performed. Depending on the timing of extubation, patients were divided into two groups: Group 1 (n = 20) – the wounded extubated in rear medical hospitals (level V); Group 2 (n = 23) – the wounded extubated at stage II+ level.
Results. The average age of the patients was 34 ± 10.0 years. In the second group, the average time from the end of surgery to extubation was 24 ± 12 minutes (95% CI 8.7–23.09). In the early postoperative period (in the first 3 days), epileptic seizures and repeated intubations were not observed in patients of the second group. At stage II+ level, the duration of ICU stay was longer in the first group than in the second (377.5 minutes versus 120 minutes; p = 0.002), and the duration of hospital stay did not differ statistically. Complications at level V occurred more frequently in the first group than in the second group (60% vs. 13%; p < 0.001), and pneumonia (30% vs. 4.3%; p = 0.037) and venous thrombosis of the lower extremities (30% vs. 4.3%; p = 0.037) were often diagnosed.
Conclusion. Early extubation of victims with gunshot wounds to the head can reduce the frequency of postoperative complications.
Supporting agencies: The work was carried out within the framework of the state assignment for research and development of the St. Petersburg State Pediatric Medical University of the Ministry of Health of the Russian Federation.
About the Authors
N. V. Ermokhina
Main Military Clinical Hospital named after Academician N. N. Burdenko
Russian Federation
Russian Federation
Ermokhina Nadezhda V., Medical Specialist at the Department of Anesthesiology and Intensive Care of the Center of Anesthesiology and Intensive Care
1-3, build. 1, Hospitalnaya Square, Moscow, 105094
G. G. Bulyshchenko
S. M. Kirov Military Medical Academy
Russian Federation
Russian Federation
Bulyshchenko Gennadi G., Cand. of Sci. (Med.), Lecturer of the Department of Neurosurgery
6, Academica Lebedeva str., Saint Petersburg, 194044
A. V. Strelnikov
Main Military Clinical Hospital named after Academician N. N. Burdenko
Russian Federation
Russian Federation
Strelnikov Alexander V., Head of the Center for Anesthesiology and Intensive Care of the Branch № 8
1-3, build. 1, Hospitalnaya Square, Moscow, 105094
A. A. Golovanov
S. M. Kirov Military Medical Academy
Russian Federation
Russian Federation
Golovanov Alexey A., Medical Specialist at the Department of Anesthesiology and Intensive Care of the Neurosurgery Clinic
6, Academica Lebedeva str., Saint Petersburg, 194044
L. V. Ermokhina
Main Military Clinical Hospital named after Academician N. N. Burdenko
Russian Federation
Russian Federation
Ermokhina Lyubov V., Cand. of Sci. (Med.), Medical Specialist at the Department of Anesthesiology and Intensive Care of the Center of Anesthesiology and Intensive Care
1-3, build. 1, Hospitalnaya Square, Moscow, 105094
V. V. Stets
Main Military Clinical Hospital named after Academician N. N. Burdenko
Russian Federation
Russian Federation
Stets Valery V., Head of the Center of Anesthesiology and Intensive Care
1-3, build. 1, Hospitalnaya Square, Moscow, 105094
J. M. Isaev
S. M. Kirov Military Medical Academy
Russian Federation
Russian Federation
Isaev Jamaludin M., Cand. of Sci. (Med.), Neurosurgeon of the Neurosurgery Clinic
6, Academica Lebedeva str., Saint Petersburg, 194044
V. K. Kisten
S. M. Kirov Military Medical Academy
Russian Federation
Russian Federation
Kisten Violetta K., Student of the Residency in the specialty «Neurosurgery»
6, Academica Lebedeva str., Saint Petersburg, 194044
A. I. Gaivoronskiy
S. M. Kirov Military Medical Academy
Russian Federation
Russian Federation
Gaivoronsky Alexey I., Dr. of Sci. (Med.), Professor, Professor of the Neurosurgery Clinic
6, Academica Lebedeva str., Saint Petersburg, 194044
D. V. Svistov
S. M. Kirov Military Medical Academy
Russian Federation
Russian Federation
Svistov Dmitry V., Cand. of Sci. (Med.), Associate Professor, Chief of the Neurosurgery Clinic
6, Academica Lebedeva str., Saint Petersburg, 194044
References
1. Akselrod B. A., Balashova E. N., Bautin A. E. et al. Clinical guidelines for red blood cell transfusion. Russian journal of hematology and transfusiology, 2018, vol. 63, no. 4, pp. 372–435. (In Russ.). https://http://doi.org/10.25837/HAT.2019.62.39.006.
2. Gizatullin Sh. Kh., Stanishevsky A. V., Svistov D. V. Combat gunshot skull and brain injuries. Burdenko’s Journal of Neurosurgery, 2021, vol. 85, no. 5, pp. 124–131. (In Russ.). https://http://doi.org/10.17116/neiro202185051124.
3. Glavatskih R. A., Davidova N. S., Leyderman I. N., Sobetova G. V. Clinical effects of adaptive lung ventilation regime during weaning of mixed ICU patients. Translational Medicine, 2022, vol. 9, no. 1, pp. 39–48. (In Russ.) http://doi.org/10.18705/2311-4495-2022-9-1-39-48.
4. Focal brain injury. Clinical guidelines / Association of Neurosurgeons of Russia. 2022. (In Russ.).
5. Kryukov E. V., Stets V. V., Chuprina A. P. et al. Clinical features of aviation medical evacuation of victims with severe combined injury. Opinion Leader, 2017, vol. 2, no. 3(5), pp. 54–58. (In Russ.).
6. Kulikov A. S. Anesthesiological aspects of accelerated postoperative recovery in neurosurgery: dis. ... Dr. of Sci. (Med.): 01/14/20 / Kulikov Alexander Sergeevich, M., 2020, 225 p. (In Russ.).
7. Maday D. Yu., Kozlov V. K., Maday O. D., Ergashev M. O. Comprehensive treatment of a victim with gunshot injury of the head complicated by infection. Pirogov Russian Journal of Surgery, 2021, no. 6, pp. 91–95. (In Russ.). http:/doi.org/10.17116/hirurgia202106191.
8. Andreenko A. A., Bratishchev I. V., Gavrilov S. V. et al. Airway management in hospital. Methodological recommendations of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” (third edition). Annals of Critical Care, 2021, vol. 2, pp. 17–81. (In Russ.). http://doi.org/10.21320/1818-474X-2021-2-17-81.
9. Meshkov N. A. Epidemiological view of combat-related injuries incurred during armed conflicts and medical rehabilitation of combatants. Bulletin of the Smolensk State Medical Academy, 2022, vol. 21, no. 4, pp. 176–190. (In Russ.).
10. Onnitsev I. Ye., Stets V. V., Kolobaeva E. G., Antokhov V. P. Principles of intensive therapy for gunshot wounds of the skull and brain. Medical Bulletin of the Main Military Clinical Hospital named after N. N. Burdenko, 2022, vol. 4, no. 10, pp. 42–49. (In Russ.). http://doi.org/10.53652/2782-1730-2022-3-4-42-49.
11. Polushin Yu. S. Blast Injuries (Lecture). Messenger of Anesthesiology and resuscitation, 2022, vol. 19, no. 6, pp. 6–17. (In Russ.). http://doi.org/10.21292/ 2078-5658-2022-19-6-6-17.
12. Safiullin D. R., Cherpakov R. A., Shabanov A. K. et al. Sevoflurane in the Acute Phase of Severe Traumatic Brain Injury. General Reanimatology, 2024, vol. 20, no. 4, pp. 4–12. (In Russ.). http://doi.org/10.15360/1813-9779-2 024-4-4-12.
13. Trishkin D. V., Kryukov E. V., Chuprina A. P. et al. Methodological recommendations for the treatment of combat surgical trauma. Moscow: Publishing House of the State Medical University of the Ministry of Defense of the Russian Federation, 2022, 373 р. (In Russ.).
14. Yaroshetsky A. I., Gritsan A. I., Avdeev S. N. et al. Diagnostics and intensive therapy of Acute Respiratory Distress Syndrome (Clinical guidelines of the Federation of Anesthesiologists and Reanimatologists of Russia). Russian Journal of Anesthesiology and Reanimatology, 2020, no. 2, pp. 5–39. (In Russ.). http://doi.org/10.17116/anaesthesiology20200215.
15. Abujaber A., Fadlalla A., Gammoh D. et al. Using trauma registry data to predict prolonged mechanical ventilation in patients with traumatic brain injury: Machine learning approach. PLoS One, 2020, vol. 15, no. 7, pp. 231–235. http://doi.org/10.1371/journal.pone.0235231.
16. Asehnoune K., Rooze P., Robba C. et al. Mechanical ventilation in patients with acute brain injury: a systematic review with meta-analysis. Crit Care, 2023, vol. 27, no. 1, pp. 221. http://doi.org/10.1186/s13054-023-04509-3.
17. Asehnoune K., Seguin P., Lasocki S. et al. Extubation success prediction in a multicentric cohort of patients with severe brain injury. Anesthesiology, 2017, vol. 127, no. 2, pp. 338–346. http://doi.org/10.1097/ALN.0000000000001725.
18. Coplin W. M., Pierson D. J., Cooley K. D. et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med, 2000, vol. 161, no. 5, pp. 1530–1536. http://doi.org/10.1164/ajrccm.161.5.9905102.
19. Dos Reis H. F. C., Gomes-Neto M., Almeida M. L. O. et al. Development of a risk score to predict extubation failure in patients with traumatic brain injury. J Crit Care, 2017, no. 42, pp. 218–222. http://doi.org/10.1016/j.jcrc.2017.07.051.
20. Fandler-Höfler S., Heschl S., Kneihsl M. et al. Ventilation time and prognosis after stroke thrombectomy: the shorter, the better! Eur J Neurol, 2020, vol. 27, no. 5, pp. 849–855. http://doi.org/10.1111/ene.14178.
21. Frisvold S. K., Robba C., Guérin C. What respiratory targets should be recommended in patients with brain injury and respiratory failure? Intensive Care Med, 2019, vol. 45, no. 5, pp. 683–686. http://doi.org/10.1007/s00134-019-05556-7.
22. Gaudet J. G., Levy C. S., Jakus L. et al. Early extubation after elective infratentorial craniotomy: results of the international PRICE survey. J Neurosurg Anesthesiol, 2024, vol. 36, no. 1, pp. 69–73. http://doi.org/10.1097/ANA.0000000000000894.
23. Godoy D. A., Rovegno M., Jibaja M. et al. Extubation after acute brain injury: an unsolved dilemma! Neurocrit Care, 2024, vol. 40, no. 2, pp. 385–390. http://doi.org/10.1007/s12028-023-01828-9.
24. Jibaja M., Sufan J. L., Godoy D. A. Controversies in weaning from mechanical ventilation and extubation in the neurocritical patient. Med Intensiv, 2018, no. 42, pp. 551–555. http://doi.org/10.1016/j.medin.2018.04.006.
25. McCredie V. A., Ferguson N. D., Pinto R. L. et al. Airway management strategies for brain-injured patients meeting standard criteria to consider extubation. A prospective cohort study. Ann Am Thorac Soc, 2017, vol. 14, no. 1, pp. 85–93. http://doi.org/10.1513/AnnalsATS.201608-620OC.
26. Meyfroidt G., Bouzat P., Casaer M. P. et al. Management of moderate to severe traumatic brain injury: an update for the intensivist. Intensive Care Med, 2022, vol. 48, no. 6, pp. 649–666. http://doi.org/10.1007/s00134-022-06702-4.
27. Newcombe V. F. J., Chow A. The features of the typical traumatic brain injury patient in the ICU are changing: what will this mean for the intensivist? Curr Opin Crit Care, 2021, vol. 27, no. 2, pp. 80–86 http://doi.org/10.1097/MCC.0000000000000814.
28. Picetti E., Bouzat P., Cattani L., Taccone F. S. Perioperative management of severe brain injured patients. Minerva Anestesiol, 2022, vol. 88, no. 5, pp. 380–9.
29. Rabinstein A. A., Cinotti R., Bösel J. Liberation from Mechanical Ventilation and Tracheostomy Practice in Traumatic Brain Injury. Neurocrit Care, 2023, vol. 38, no. 2, pp. 439–446. http://doi.org/10.1007/s12028-023-01693-6.
30. Robba C., Poole D., McNett M. et al. Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus. Intensive Care Med, 2020, vol. 46, no. 12, pp. 2397–2410. http://doi.org/10.1007/s00134-020-06283-0.
31. Tejerina E. E., Robba C., Del Campo-Albendea L. et al. Weaning Outcomes in Patients with Brain Injury. Neurocrit Care, 2022, vol. 37, no. 3, pp. 649–659. http://doi.org/10.1007/s12028-022-01584-2.
32. Wiles M. D., Braganza M., Edwards H. et al. Management of traumatic brain injury in the non-neurosurgical intensive care unit: a narrative review of current evidence. Anaesthesia, 2023, vol. 78, no. 4, pp. 510–520. http://doi.org/10.1111/anae.15898.
33. Ziaka M., Exadaktylos A. Brain-lung interactions and mechanical ventilation in patients with isolated brain injury. Crit Care, 2021, vol. 25, no. 1, pp. 358. http://doi.org/10.1186/s13054-021-03778-0.
Review
For citations:
Ermokhina N.V., Bulyshchenko G.G., Strelnikov A.V., Golovanov A.A., Ermokhina L.V., Stets V.V., Isaev J.M., Kisten V.K., Gaivoronskiy A.I., Svistov D.V. Extubation of patients with a gunshot penetrating head wound at the advanced stages of medical evacuation. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2025;22(5):60-69. (In Russ.) https://doi.org/10.24884/2078-5658-2025-22-5-60-69
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