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Observational Study
. 2020 May;46(5):983-994.
doi: 10.1007/s00134-020-05935-5. Epub 2020 Feb 5.

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

Chiara Robba  1   2 , Stefania Galimberti  2   3 , Francesca Graziano  2   3 , Eveline J A Wiegers  4 , Hester F Lingsma  4 , Carolina Iaquaniello  2 , Nino Stocchetti  5   6 , David Menon  7 , Giuseppe Citerio  8   9 ; CENTER-TBI ICU Participants and Investigators
Collaborators, Affiliations
Observational Study

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

Chiara Robba et al. Intensive Care Med. 2020 May.

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.

Keywords: Mechanical ventilation; Outcome; Tracheostomy; Traumatic Brain Injury.

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Conflict of interest statement

GC is Editor-in-Chief of Intensive Care Medicine. GC reports grants, personal fees as Speakers’ Bureau Member and Advisory Board Member from Integra and Neuroptics; personal fees from Nestle and UCB Pharma, all outside of the submitted work. DKM reports grants from the European Union and UK National Institute for Health Research, during the conduct of the study; grants, personal fees, and non-financial support from GlaxoSmithKline; personal fees from Neurotrauma Sciences, Lantmaanen AB, Pressura, and Pfizer, outside of the submitted work. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Left panel (a). Percentage distribution of the decision to perform tracheostomy or not in each country (in blind). Only countries that have at least 20 patients admitted in ICU are reported alone; the remaining are grouped. Right panel (b). Percentage of early vs. late tracheostomy by centre with at least five tracheostomies. Centres within the same country have the same colour and a mass proportional to centre size. The bisector line is also reported. Results are adjusted for confounding factors
See this image and copyright information in PMC

Comment in

References

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