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.
Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study / Robba, C.; Galimberti, S.; Graziano, F.; Wiegers, E. J. A.; Lingsma, H. F.; Iaquaniello, C.; Stocchetti, N.; Menon, D.; Citerio, G.; Akerlund, C.; Amrein, K.; Andelic, N.; Andreassen, L.; Anke, A.; Audibert, G.; Azouvi, P.; Azzolini, M. L.; Bartels, R.; Beer, R.; Bellander, B. -M.; Benali, H.; Berardino, M.; Beretta, L.; Biqiri, E.; Blaabjerg, M.; Lund, S. B.; Brorsson, C.; Buki, A.; Cabeleira, M.; Caccioppola, A.; Calappi, E.; Calvi, M. R.; Cameron, P.; Lozano, G. C.; Carbonara, M.; Castano-Leon, A. M.; Chevallard, G.; Chieregato, A.; Citerio, G.; Coburn, M.; Coles, J.; Cooper, J. D.; Correia, M.; Czeiter, E.; Czosnyka, M.; Dahyot-Fizelier, C.; De Keyser, V.; Degos, V.; Corte, F. D.; Boogert, H.; Depreitere, B.; Dilvesi, D.; Dixit, A.; Dreier, J.; Duliere, G. -L.; Ercole, A.; Ezer, E.; Fabricius, M.; Foks, K.; Frisvold, S.; Furmanov, A.; Galanaud, D.; Gantner, D.; Ghuysen, A.; Giga, L.; Golubovic, J.; Gomez, P. A.; Grossi, F.; Gupta, D.; Haitsma, I.; Helbok, R.; Helseth, E.; Hutchinson, P. J.; Jankowski, S.; Karan, M.; Kolias, A. G.; Kondziella, D.; Koraropoulos, E.; Koskinen, L. -O.; Kovacs, N.; Kowark, A.; Lagares, A.; Laureys, S.; Lejeune, A.; Lightfoot, R.; Lingsma, H.; Maas, A. I. R.; Manara, A.; Martino, C.; Marechal, H.; Mattern, J.; Mcmahon, C.; Menovsky, T.; Mulazzi, D.; Muraleedharan, V.; Murray, L.; Nair, N.; Negru, A.; Nelson, D.; Newcombe, V.; Noirhomme, Q.; Nyiradi, J.; Ortolano, F.; Payen, J. -F.; Perlbarg, V.; Persona, P.; Peul, W.; Piippo-Karjalainen, A.; Ples, H.; Pomposo, I.; Posti, J. P.; Puybasset, L.; Radoi, A.; Ragauskas, A.; Raj, R.; Rhodes, J.; Richter, S.; Rocka, S.; Roe, C.; Roise, O.; Rosenfeld, J. V.; Rosenlund, C.; Rosenthal, G.; Rossaint, R.; Rossi, S.; Sahuquillo, J.; Sandro, O.; Sakowitz, O.; Sanchez-Porras, R.; Schirmer-Mikalsen, K.; Schou, R. F.; Smielewski, P.; Sorinola, A.; Stamatakis, E.; Steyerberg, E. W.; Sundstrom, N.; Takala, R.; Tamas, V.; Tamosuitis, T.; Tenovuo, O.; Thomas, M.; Tibboe, D.; Tolias, C.; Trapani, T.; Tudora, C. M.; Vajkoczy, P.; Vallance, S.; Valeinis, E.; Vamos, Z.; Van der Steen, G.; van Dijck, J. T. J. M.; van Essen, T. A.; Vanhaudenhuyse, A.; van Wijk, R. P. J.; Vargiolu, A.; Vega, E.; Vik, A.; Vilcinis, R.; Volovici, V.; Voormolen, D.; Vulekovic, P.; Williams, G.; Winzeck, S.; Wolf, S.; Younsi, A.; Zeiler, F. A.; Ziverte, A.; Zoerle, T.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 46:5(2020), pp. 983-994-994. [10.1007/s00134-020-05935-5]
Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
Beretta L.Membro del Collaboration Group
;Martino C.;
2020-01-01
Abstract
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
