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

N. Stocchetti;A. Caccioppola;T. Zoerle
Ultimo
Membro del Collaboration Group
2020-05-01

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.
Mechanical ventilation; Outcome; Tracheostomy; Traumatic Brain Injury
Settore MED/41 - Anestesiologia
feb-2020
Article (author)
File in questo prodotto:
File Dimensione Formato  
Robba2020_Article_TracheostomyPracticeAndTimingI.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 932.4 kB
Formato Adobe PDF
932.4 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/772509
Citazioni
  • ???jsp.display-item.citation.pmc??? 10
  • Scopus 26
  • ???jsp.display-item.citation.isi??? 27
social impact