TY - JOUR
T1 - Tracheostomy practice and timing in traumatic brain-injured patients
T2 - a CENTER-TBI study
AU - Robba, Chiara
AU - Galimberti, Stefania
AU - Graziano, Francesca
AU - Wiegers, Eveline J.A.
AU - Lingsma, Hester
AU - Iaquaniello, Carolina
AU - Stocchetti, Nino
AU - Menon, David
AU - Citerio, Giuseppe
AU - Åkerlund, Cecilia
AU - Amrein, Krisztina
AU - Andelic, Nada
AU - Andreassen, Lasse
AU - Anke, Audny
AU - Audibert, Gérard
AU - Azouvi, Philippe
AU - Azzolini, Maria Luisa
AU - Bartels, Ronald
AU - Beer, Ronny
AU - Bellander, Bo Michael
AU - Benali, Habib
AU - Berardino, Maurizio
AU - Beretta, Luigi
AU - Biqiri, Erta
AU - Blaabjerg, Morten
AU - Lund, Stine Borgen
AU - Brorsson, Camilla
AU - Buki, Andras
AU - Cabeleira, Manuel
AU - Caccioppola, Alessio
AU - Calappi, Emiliana
AU - Calvi, Maria Rosa
AU - Cameron, Peter
AU - Lozano, Guillermo Carbayo
AU - Carbonara, Marco
AU - Castaño-León, Ana M.
AU - Chevallard, Giorgio
AU - Chieregato, Arturo
AU - Citerio, Giuseppe
AU - Coburn, Mark
AU - Coles, Jonathan
AU - Cooper, Jamie D.
AU - Correia, Marta
AU - Czeiter, Endre
AU - Czosnyka, Marek
AU - Dahyot-Fizelier, Claire
AU - De Keyser, Véronique
AU - Degos, Vincent
AU - Corte, Francesco Della
AU - Boogert, Hugo den
AU - Depreitere, Bart
AU - Dilvesi, Dula
AU - Dixit, Abhishek
AU - Dreier, Jens
AU - Dulière, Guy Loup
AU - Ercole, Ari
AU - Ezer, Erzsébet
AU - Fabricius, Martin
AU - Foks, Kelly
AU - Frisvold, Shirin
AU - Furmanov, Alex
AU - Galanaud, Damien
AU - Gantner, Dashiell
AU - Ghuysen, Alexandre
AU - Giga, Lelde
AU - Golubovic, Jagos
AU - Gomez, Pedro A.
AU - Grossi, Francesca
AU - Gupta, Deepak
AU - Haitsma, Iain
AU - Helbok, Raimund
AU - Helseth, Eirik
AU - Hutchinson, Peter J.
AU - Jankowski, Stefan
AU - Karan, Mladen
AU - Kolias, Angelos G.
AU - Kondziella, Daniel
AU - Koraropoulos, Evgenios
AU - Koskinen, Lars Owe
AU - Kovács, Noémi
AU - Kowark, Ana
AU - Lagares, Alfonso
AU - Laureys, Steven
AU - Lejeune, Aurelie
AU - Lightfoot, Roger
AU - Lingsma, Hester
AU - Maas, Andrew I.R.
AU - Manara, Alex
AU - Martino, Costanza
AU - Maréchal, Hugues
AU - Mattern, Julia
AU - McMahon, Catherine
AU - Menovsky, Tomas
AU - Mulazzi, Davide
AU - Muraleedharan, Visakh
AU - Murray, Lynnette
AU - Nair, Nandesh
AU - Negru, Ancuta
AU - Nelson, David
AU - Newcombe, Virginia
AU - Noirhomme, Quentin
AU - Nyirádi, József
AU - Ortolano, Fabrizio
AU - Payen, Jean François
AU - Perlbarg, Vincent
AU - Persona, Paolo
AU - Peul, Wilco
AU - Piippo-Karjalainen, Anna
AU - Ples, Horia
AU - Pomposo, Inigo
AU - Posti, Jussi P.
AU - Puybasset, Louis
AU - Radoi, Andreea
AU - Ragauskas, Arminas
AU - Raj, Rahul
AU - Rhodes, Jonathan
AU - Richter, Sophie
AU - Rocka, Saulius
AU - Roe, Cecilie
AU - Roise, Olav
AU - Rosenfeld, Jeffrey V.
AU - Rosenlund, Christina
AU - Rosenthal, Guy
AU - Rossaint, Rolf
AU - Rossi, Sandra
AU - Sahuquillo, Juan
AU - Sandro, Oddrun
AU - Sakowitz, Oliver
AU - Sanchez-Porras, Renan
AU - Schirmer-Mikalsen, Kari
AU - Schou, Rico Frederik
AU - Smielewski, Peter
AU - Sorinola, Abayomi
AU - Stamatakis, Emmanuel
AU - Steyerberg, Ewout W.
AU - Sundström, Nina
AU - Takala, Riikka
AU - Tamás, Viktória
AU - Tamosuitis, Tomas
AU - Tenovuo, Olli
AU - Thomas, Matt
AU - Tibboe, Dick
AU - Tolias, Christos
AU - Trapani, Tony
AU - Tudora, Cristina Maria
AU - Vajkoczy, Peter
AU - Vallance, Shirley
AU - Valeinis, Egils
AU - Vámos, Zoltán
AU - Van der Steen, Gregory
AU - van Dijck, Jeroen T.J.M.
AU - van Essen, Thomas A.
AU - Vanhaudenhuyse, Audrey
AU - van Wijk, Roel P.J.
AU - Vargiolu, Alessia
AU - Vega, Emmanuel
AU - Vik, Anne
AU - Vilcinis, Rimantas
AU - Volovici, Victor
AU - Voormolen, Daphne
AU - Vulekovic, Petar
AU - Williams, Guy
AU - Winzeck, Stefan
AU - Wolf, Stefan
AU - Younsi, Alexander
AU - Zeiler, Frederick A.
AU - Ziverte, Agate
AU - Zoerle, Tommaso
AU - the CENTER-TBI ICU Participants and Investigators
PY - 2020/5
Y1 - 2020/5
N2 - 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.
AB - 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.
KW - Mechanical ventilation
KW - Outcome
KW - Tracheostomy
KW - Traumatic Brain Injury
UR - http://www.scopus.com/inward/record.url?scp=85079168843&partnerID=8YFLogxK
U2 - 10.1007/s00134-020-05935-5
DO - 10.1007/s00134-020-05935-5
M3 - Article
C2 - 32025780
AN - SCOPUS:85079168843
SP - 983
EP - 994
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
ER -