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Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study

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 a...

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Autores principales: Robba, Chiara, Galimberti, Stefania, Graziano, Francesca, Wiegers, Eveline J. A., Lingsma, Hester F., Iaquaniello, Carolina, Stocchetti, Nino, Menon, David, Citerio, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223805/
https://www.ncbi.nlm.nih.gov/pubmed/32025780
http://dx.doi.org/10.1007/s00134-020-05935-5
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author Robba, Chiara
Galimberti, Stefania
Graziano, Francesca
Wiegers, Eveline J. A.
Lingsma, Hester F.
Iaquaniello, Carolina
Stocchetti, Nino
Menon, David
Citerio, Giuseppe
author_facet Robba, Chiara
Galimberti, Stefania
Graziano, Francesca
Wiegers, Eveline J. A.
Lingsma, Hester F.
Iaquaniello, Carolina
Stocchetti, Nino
Menon, David
Citerio, Giuseppe
author_sort Robba, Chiara
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-05935-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-72238052020-05-15 Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study Robba, Chiara Galimberti, Stefania Graziano, Francesca Wiegers, Eveline J. A. Lingsma, Hester F. Iaquaniello, Carolina Stocchetti, Nino Menon, David Citerio, Giuseppe Intensive Care Med Original 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-05935-5) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-02-05 2020 /pmc/articles/PMC7223805/ /pubmed/32025780 http://dx.doi.org/10.1007/s00134-020-05935-5 Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original
Robba, Chiara
Galimberti, Stefania
Graziano, Francesca
Wiegers, Eveline J. A.
Lingsma, Hester F.
Iaquaniello, Carolina
Stocchetti, Nino
Menon, David
Citerio, Giuseppe
Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
title Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
title_full Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
title_fullStr Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
title_full_unstemmed Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
title_short Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
title_sort tracheostomy practice and timing in traumatic brain-injured patients: a center-tbi study
topic Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223805/
https://www.ncbi.nlm.nih.gov/pubmed/32025780
http://dx.doi.org/10.1007/s00134-020-05935-5
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