Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
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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; Åkerlund, Cecilia; Amrein, Krisztina; Andelic, Nada; Andreassen, Lasse; Anke, Audny; Audibert, Gérard; Azouvi, Philippe; Azzolini, Maria Luisa; Bartels, Ronald; Beer, Ronny; Bellander, Bo Michael; Benali, Habib; Berardino, Maurizio; Beretta, Luigi; Biqiri, Erta; Blaabjerg, Morten; Lund, Stine Borgen; Brorsson, Camilla; Buki, Andras; Cabeleira, Manuel; Caccioppola, Alessio; Calappi, Emiliana; Calvi, Maria Rosa; Cameron, Peter; Lozano, Guillermo Carbayo; Carbonara, Marco; Castaño-León, Ana M.; Chevallard, Giorgio; Chieregato, Arturo; Coburn, Mark; Coles, Jonathan; Cooper, Jamie D.; Correia, Marta; Czeiter, Endre; Czosnyka, Marek; Dahyot-Fizelier, Claire; De Keyser, Véronique; Degos, Vincent; Fabricius, Martin; Kondziella, Daniel; Nelson, David; The CENTER-TBI ICU Participants and Investigators.
In: Intensive Care Medicine, Vol. 46, No. 5, 2020, p. 983-994.Research output: Contribution to journal › Journal article › Research › peer-review
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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 F.
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 - 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 - Fabricius, Martin
AU - Kondziella, Daniel
AU - Nelson, David
AU - The CENTER-TBI ICU Participants and Investigators
PY - 2020
Y1 - 2020
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
U2 - 10.1007/s00134-020-05935-5
DO - 10.1007/s00134-020-05935-5
M3 - Journal article
C2 - 32025780
AN - SCOPUS:85079168843
VL - 46
SP - 983
EP - 994
JO - European Journal of Intensive Care Medicine
JF - European Journal of Intensive Care Medicine
SN - 0935-1701
IS - 5
ER -
ID: 253444250