Effects of Direct Tracheostomy on Ventilator Weaning in Patients Intubated for Guillain-Barré Syndrome
Abstract
Background: Whether or not a direct tracheostomy without any prior weaning attempt is beneficial in patients intubated for Guillain-Barré syndrome (GBS) remains to be determined. Our objective was to determine whether direct tracheostomy results in earlier or later ventilator weaning compared to standard weaning. Methods: Multicenter, retrospective cohort study including all patients intubated for GBS over a 10-year period (2014-2023). We compared patients having undergone direct tracheostomy without any prior weaning attempt with those having undergone standard weaning (spontaneous-breathing trial or extubation attempt). We also compared direct tracheostomy with tracheostomy after weaning failure. The primary outcome was the proportion of patients alive and free from mechanical ventilation 28 days after weaning initiation. Results: Overall, 221 patients (45%) underwent direct tracheostomy and 273 (55%) standard weaning. Compared to patients with standard weaning, those with direct tracheostomy were less likely to be alive and free from mechanical ventilation at day 28 (43% vs. 83%, p < 0.001). Using G-computation to estimate the marginal causal effect of the weaning strategy, standard weaning was more effective than direct tracheostomy in reducing the risk of remaining under mechanical ventilation at day 28: -39.5% [95% Confidence Interval, -47.3% to -31.5%]. Even when compared to patients having undergone tracheostomy after weaning failure, those with direct tracheostomy were less likely to be alive and free from mechanical ventilation 28 days after the tracheostomy procedure. Interpretation: A direct tracheostomy without any prior weaning attempt might significantly delay the ventilator weaning process in patients intubated for GBS. Clinical Trial Registration: NCT07022028.
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BibTeX
@article{thille2026effects,
title = {{Effects of Direct Tracheostomy on Ventilator Weaning in Patients Intubated for Guillain-Barré Syndrome}},
author = {Arnaud W. Thille and Constance Bayon and Marie Gauvrit and Clément Saccheri and Marie Labruyère and Gaëtan Béduneau and Guilhem Wattecamps and Matthieu Henry and Eddine Bendiab and Benjamin Swinyard and Arnaud Gacouin and Adam Celier and Benjamin Foucou and Suzanne Champion and Anne-Fleur Haudebourg and Laurence Dangers and Rémi Coudroy and Olivier Plateker and Cédric Daubin and Lucie Fromont and Charlotte Guesdon and Emmanuel Vivier and Lev Volkov and Cyril Potier and Jeremy Bourenne and Charlotte Chiquet and Valentin Pointurier and Louis Chauvelot and Pierre Bailly and David Schnell and Nicholas Sedillot and Florian Reizine and Laurent Argaud and Faustine Reynaud and Juliette Pelle and Olivier Lesieur and Adrien Auvet and Guillaume Lacave and Marion Kernevez and Damien Contou and Guillaume Grillet and Arnaud Delahaye and Julio Badie and Jerome Devaquet and Hermine Chauvin and Alexandra Beurton and Emanuele Turbil and Jean-Philippe Rigaud and Stéphanie Ragot and Louis Chamblet and Sylvain Le Pape},
journal = {Annals of Intensive Care},
year = {2026},
month = oct,
doi = {10.1016/j.aicoj.2026.100124},
url = {https://normandie-univ.hal.science/hal-05835292v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Effects of Direct Tracheostomy on Ventilator Weaning in Patients Intubated for Guillain-Barré Syndrome
AU - Arnaud W. Thille
AU - Constance Bayon
AU - Marie Gauvrit
AU - Clément Saccheri
AU - Marie Labruyère
AU - Gaëtan Béduneau
AU - Guilhem Wattecamps
AU - Matthieu Henry
AU - Eddine Bendiab
AU - Benjamin Swinyard
AU - Arnaud Gacouin
AU - Adam Celier
AU - Benjamin Foucou
AU - Suzanne Champion
AU - Anne-Fleur Haudebourg
AU - Laurence Dangers
AU - Rémi Coudroy
AU - Olivier Plateker
AU - Cédric Daubin
AU - Lucie Fromont
AU - Charlotte Guesdon
AU - Emmanuel Vivier
AU - Lev Volkov
AU - Cyril Potier
AU - Jeremy Bourenne
AU - Charlotte Chiquet
AU - Valentin Pointurier
AU - Louis Chauvelot
AU - Pierre Bailly
AU - David Schnell
AU - Nicholas Sedillot
AU - Florian Reizine
AU - Laurent Argaud
AU - Faustine Reynaud
AU - Juliette Pelle
AU - Olivier Lesieur
AU - Adrien Auvet
AU - Guillaume Lacave
AU - Marion Kernevez
AU - Damien Contou
AU - Guillaume Grillet
AU - Arnaud Delahaye
AU - Julio Badie
AU - Jerome Devaquet
AU - Hermine Chauvin
AU - Alexandra Beurton
AU - Emanuele Turbil
AU - Jean-Philippe Rigaud
AU - Stéphanie Ragot
AU - Louis Chamblet
AU - Sylvain Le Pape
PY - 2026
DA - 2026/10/22
JO - Annals of Intensive Care
DO - 10.1016/j.aicoj.2026.100124
UR - https://normandie-univ.hal.science/hal-05835292v1
AB - Background: Whether or not a direct tracheostomy without any prior weaning attempt is beneficial in patients intubated for Guillain-Barré syndrome (GBS) remains to be determined. Our objective was to determine whether direct tracheostomy results in earlier or later ventilator weaning compared to standard weaning. Methods: Multicenter, retrospective cohort study including all patients intubated for GBS over a 10-year period (2014-2023). We compared patients having undergone direct tracheostomy without any prior weaning attempt with those having undergone standard weaning (spontaneous-breathing trial or extubation attempt). We also compared direct tracheostomy with tracheostomy after weaning failure. The primary outcome was the proportion of patients alive and free from mechanical ventilation 28 days after weaning initiation. Results: Overall, 221 patients (45%) underwent direct tracheostomy and 273 (55%) standard weaning. Compared to patients with standard weaning, those with direct tracheostomy were less likely to be alive and free from mechanical ventilation at day 28 (43% vs. 83%, p < 0.001). Using G-computation to estimate the marginal causal effect of the weaning strategy, standard weaning was more effective than direct tracheostomy in reducing the risk of remaining under mechanical ventilation at day 28: -39.5% [95% Confidence Interval, -47.3% to -31.5%]. Even when compared to patients having undergone tracheostomy after weaning failure, those with direct tracheostomy were less likely to be alive and free from mechanical ventilation 28 days after the tracheostomy procedure. Interpretation: A direct tracheostomy without any prior weaning attempt might significantly delay the ventilator weaning process in patients intubated for GBS. Clinical Trial Registration: NCT07022028.
SN - 2110-5820
ER -