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.-.; 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.; 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.-.; 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.-.; 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.-.; 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.

doi:10.1007/s00134-020-05935-5

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

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.;N. Stocchetti;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.;A. Caccioppola;Calappi E.;Calvi M. R.;Cameron P.;Lozano G. C.;Carbonara M.;Castano-Leon A. M.;Chevallard G.;Chieregato A.;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.;T. Zoerle^{Ultimo

Membro del Collaboration Group}

2020

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.

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	Parole chiave
	
			Mechanical ventilation; Outcome; Tracheostomy; Traumatic Brain Injury
		
	Settori scientifico-disciplinari dell'articolo
	
			Settore MED/41 - Anestesiologia
		
	Data di pubblicazione
	
			1-mag-2020
		
	Data ahead of print o data di stampa
	
			feb-2020
		
	Rivista in ANCE
	
			INTENSIVE CARE MEDICINE
		
	DOI
	
			https://dx.doi.org/10.1007/s00134-020-05935-5
		
	Tipologia
	
			Article (author)
		
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			01 - Articolo su periodico

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