TY - JOUR
T1 - Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
AU - The CENTER-TBI ICU Participants and Investigators
AU - Robba, C.
AU - Galimberti, S.
AU - Graziano, F.
AU - Wiegers, E.J.A.
AU - Lingsma, H.F.
AU - Iaquaniello, C.
AU - Stocchetti, N.
AU - Menon, D.
AU - Citerio, G.
AU - Åkerlund, C.
AU - Amrein, K.
AU - Andelic, N.
AU - Andreassen, L.
AU - Anke, A.
AU - Audibert, G.
AU - Azouvi, P.
AU - Azzolini, M.L.
AU - Bartels, R.
AU - Beer, R.
AU - Bellander, B.-M.
AU - Benali, H.
AU - Berardino, M.
AU - Beretta, L.
AU - Biqiri, E.
AU - Blaabjerg, M.
AU - Lund, S.B.
AU - Brorsson, C.
AU - Buki, A.
AU - Cabeleira, M.
AU - Caccioppola, A.
AU - Calappi, E.
AU - Calvi, M.R.
AU - Cameron, P.
AU - Lozano, G.C.
AU - Carbonara, M.
AU - Castaño-León, A.M.
AU - Chevallard, G.
AU - Chieregato, A.
AU - Coburn, M.
AU - Coles, J.
AU - Cooper, J.D.
AU - Correia, M.
AU - Czeiter, E.
AU - Czosnyka, M.
AU - Dahyot-Fizelier, C.
AU - Grossi, F.
AU - Martino, C.
AU - Ortolano, F.
AU - Rossi, S.
AU - Zoerle, T.
N1 - Export Date: 27 May 2020
PY - 2020
Y1 - 2020
N2 - Purpose: Indications and optimal timing for tracheostomy in traumatic brain-injured (TBI) patients are uncertain. This study aims to describe the patients’ characteristics, timing, and factors related to the decision to perform a tracheostomy and differences in strategies among different countries and assess the effect of the timing of tracheostomy on patients’ outcomes. Methods: We selected TBI patients from CENTER-TBI, a prospective observational longitudinal cohort study, with an intensive care unit stay ≥ 72 h. Tracheostomy was defined as early (≤ 7 days from admission) or late (> 7 days). We used a Cox regression model to identify critical factors that affected the timing of tracheostomy. The outcome was assessed at 6 months using the extended Glasgow Outcome Score. Results: Of the 1358 included patients, 433 (31.8%) had a tracheostomy. Age (hazard rate, HR = 1.04, 95% CI = 1.01–1.07, p = 0.003), Glasgow coma scale ≤ 8 (HR = 1.70, 95% CI = 1.22–2.36 at 7; p < 0.001), thoracic trauma (HR = 1.24, 95% CI = 1.01–1.52, p = 0.020), hypoxemia (HR = 1.37, 95% CI = 1.05–1.79, p = 0.048), unreactive pupil (HR = 1.76, 95% CI = 1.27–2.45 at 7; p < 0.001) were predictors for tracheostomy. Considerable heterogeneity among countries was found in tracheostomy frequency (7.9–50.2%) and timing (early 0–17.6%). Patients with a late tracheostomy were more likely to have a worse neurological outcome, i.e., mortality and poor neurological sequels (OR = 1.69, 95% CI = 1.07–2.67, p = 0.018), and longer length of stay (LOS) (38.5 vs. 49.4 days, p = 0.003). Conclusions: Tracheostomy after TBI is routinely performed in severe neurological damaged patients. Early tracheostomy is associated with a better neurological outcome and reduced LOS, but the causality of this relationship remains unproven.
AB - Purpose: Indications and optimal timing for tracheostomy in traumatic brain-injured (TBI) patients are uncertain. This study aims to describe the patients’ characteristics, timing, and factors related to the decision to perform a tracheostomy and differences in strategies among different countries and assess the effect of the timing of tracheostomy on patients’ outcomes. Methods: We selected TBI patients from CENTER-TBI, a prospective observational longitudinal cohort study, with an intensive care unit stay ≥ 72 h. Tracheostomy was defined as early (≤ 7 days from admission) or late (> 7 days). We used a Cox regression model to identify critical factors that affected the timing of tracheostomy. The outcome was assessed at 6 months using the extended Glasgow Outcome Score. Results: Of the 1358 included patients, 433 (31.8%) had a tracheostomy. Age (hazard rate, HR = 1.04, 95% CI = 1.01–1.07, p = 0.003), Glasgow coma scale ≤ 8 (HR = 1.70, 95% CI = 1.22–2.36 at 7; p < 0.001), thoracic trauma (HR = 1.24, 95% CI = 1.01–1.52, p = 0.020), hypoxemia (HR = 1.37, 95% CI = 1.05–1.79, p = 0.048), unreactive pupil (HR = 1.76, 95% CI = 1.27–2.45 at 7; p < 0.001) were predictors for tracheostomy. Considerable heterogeneity among countries was found in tracheostomy frequency (7.9–50.2%) and timing (early 0–17.6%). Patients with a late tracheostomy were more likely to have a worse neurological outcome, i.e., mortality and poor neurological sequels (OR = 1.69, 95% CI = 1.07–2.67, p = 0.018), and longer length of stay (LOS) (38.5 vs. 49.4 days, p = 0.003). Conclusions: Tracheostomy after TBI is routinely performed in severe neurological damaged patients. Early tracheostomy is associated with a better neurological outcome and reduced LOS, but the causality of this relationship remains unproven.
KW - Mechanical ventilation
KW - Outcome
KW - Tracheostomy
KW - Traumatic Brain Injury
U2 - 10.1007/s00134-020-05935-5
DO - 10.1007/s00134-020-05935-5
M3 - Article
VL - 46
SP - 983
EP - 994
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 5
ER -