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Multicenter Study
. 2018 Aug 17;22(1):195.
doi: 10.1186/s13054-018-2126-6.

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Toshikazu Abe  1   2 , Fabiana Madotto  3 , Tài Pham  4   5 , Isao Nagata  6 , Masatoshi Uchida  6 , Nanako Tamiya  6 , Kiyoyasu Kurahashi  7 , Giacomo Bellani  8 , John G Laffey  4   5   9 ; LUNG-SAFE Investigators and the ESICM Trials Group
Collaborators, Affiliations
Multicenter Study

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Toshikazu Abe et al. Crit Care. .

Abstract

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study.

Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort.

Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample.

Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality.

Trial registration: ClinicalTrials.gov, NCT02010073 . Registered on 12 December 2013.

Keywords: Acute respiratory distress syndrome (ARDS); ICU; Propensity-matched analysis; Tracheostomy; Ventilation.

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Conflict of interest statement

Ethics approval and consent to participate

All participating ICUs obtained ethics committee approval and obtained either patient consent or ethics committee waiver of consent in the LUNG-SAFE study. The study protocol was also reviewed and approved by the ethics committee of Mito Kyodo General Hospital, University of Tsukuba Hospital Mito Medical Center, Japan.

Consent for publication

Not applicable.

Competing interests

All authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of study participants. AHRF, acute hypoxic respiratory failure; ARDS, acute respiratory distress syndrome, Pts, patients; COPD, chronic obstructive pulmonary disease
Fig. 2
Fig. 2
Distribution of time to tracheostomy (n = 309)
Fig. 3
Fig. 3
1 Survival probability during the first 28 days. 2 Survival probability during the first 60 days. 3 Survival probability during the first 90 days
Fig. 4
Fig. 4
Distribution of the logit of propensity scores in patients with tracheostomy (n = 267) and without tracheostomy (n = 267) in the matched sample
Fig. 5
Fig. 5
Survival probability during the hospital stay in the matched sample (n = 534). Kaplan Meier’s approach, assuming as censored, those patients discharged and alive before day 90
See this image and copyright information in PMC

References

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