Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
- 5 February 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 46 (5), 983-994
- https://doi.org/10.1007/s00134-020-05935-5
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
Funding Information
- FP7 Health (602150, 602150)
- FP7 Health (602150)
This publication has 27 references indexed in Scilit:
- Early versus late tracheostomy for critically ill patientsEmergencias, 2015
- Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI)Neurosurgery, 2015
- Tracheostomy timing in traumatic brain injuryThe Journal of Trauma and Acute Care Surgery, 2014
- Stroke-Related Early Tracheostomy Versus Prolonged Orotracheal Intubation in Neurocritical Care Trial (SETPOINT)Stroke, 2013
- Liberation of neurosurgical patients from mechanical ventilation and tracheostomy in neurocritical careJournal of Critical Care, 2011
- Rate of reintubation in mechanically ventilated neurosurgical and neurologic patients: Evaluation of a systematic approach to weaning and extubationCritical Care Medicine, 2008
- Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patientsIntensive Care Medicine, 2008
- Discontinuing Mechanical Ventilatory SupportSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2007
- IMPACT Database of Traumatic Brain Injury: Design And DescriptionJournal of Neurotrauma, 2007
- Structured Interviews for the Glasgow Outcome Scale and the Extended Glasgow Outcome Scale: Guidelines for Their UseJournal of Neurotrauma, 1998