Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
Robba, Chiara; Galimberti, Stefania; Graziano, Francesca; Wiegers, E; Lingsma, Hester F; Iaquaniello, Carolina; Stocchetti, Nino; Menon, David; Citerio, Giuseppe; Andelic, Nada; Andreassen, Lasse; Anke, Audny; Lund, Stine Borgen; Frisvold, Shirin; Helseth, Eirik; Røe, Cecilie; Røise, Olav; Sandrød, Oddrun; Schirmer-Mikalsen, Kari; Vik, Anne; Åkerlund, Cecilia; Amrein, Krisztina; Audibert, Gerard; Azouvi, Philippe; Azzolini, Maria Luisa; Bartels, Ronald; Beer, Ronny; Bellander, Bo-Michael; Benali, Habib; Berardino, Maurizio; Beretta, Luigi; Biqiri, Erta; Blaabjerg, Morten; Brorsson, Camilla; Buki, Andras; Cabeleira, Manuel; Caccioppola, Alessio; Calappi, Emiliana; Calvi, Maria Rosa; Cameron, Peter; Lozano, Guillermo Carbayo; Carbonara, Marco; Castaño-León, Ana M.; Chevallard, Giorgio; Chieregato, Arturo; Coburn, Mark; Coles, Jonathan; Cooper, Jamie; Correia, Marta; Czeiter, Endre
Peer reviewed, Journal article
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Original versionIntensive Care Medicine. 2020, 46 983-994. 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.