Article (Scientific journals)
Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
Robba, C.; Galimberti, S.; Graziano, F. et al.
2020In Intensive Care Medicine, 46
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Keywords :
Mechanical ventilation; Outcome; Tracheostomy; Traumatic Brain Injury
Abstract :
[en] 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. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
Research Center/Unit :
CHU de Liège-Centre du Cerveau² - ULiège
Disciplines :
Neurosciences & behavior
Author, co-author :
Robba, C.;  Department of Anaesthesia and Intensive Care, Policlinico San Martino IRCCS for Oncology and Neuroscience, Genoa, Italy, School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
Galimberti, S.;  School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy, Centre of Biostatistics for Clinical Epidemiology, University of Milano - Bicocca, Monza, Italy
Graziano, F.;  School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy, Centre of Biostatistics for Clinical Epidemiology, University of Milano - Bicocca, Monza, Italy
Wiegers, E. J. A.;  Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
Lingsma, H. F.;  Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
Iaquaniello, C.;  School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
Stocchetti, N.;  Department of Physiopathology and Transplantation, Milan University, Milan, Italy, Neuro ICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Menon, D.;  Department of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
Citerio, G.;  School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy, Neurointensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
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De Keyser, Véronique ;  Université de Liège - ULiège > Département de Psychologie > Département de Psychologie
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Gantner, D.
Ghuysen, Alexandre ;  Université de Liège - ULiège > Département des sciences de la santé publique > Simulation médicale en situation critique
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Golubovic, J.
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Laureys, Steven  ;  Université de Liège - ULiège > Giga Consciousness-Coma Science Group
Lejeune, Aurélie
Lightfoot, R.
Lingsma, H.;  Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
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Muraleedharan, V.
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Newcombe, V.
Noirhomme, Quentin ;  Université de Liège - ULiège > GIGA CRC In vivo Imaging
Nyirádi, J.
Ortolano, F.
Payen, J.-F.
Perlbarg, V.
Persona, P.
Peul, W.
Piippo-Karjalainen, A.
Ples, H.
Pomposo, I.
Posti, J. P.
Puybasset, L.
Radoi, A.
Ragauskas, A.
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Rhodes, J.
Richter, S.
Rocka, S.
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Rosenfeld, J. V.
Rosenlund, C.
Rosenthal, G.
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Vargiolu, A.
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Voormolen, D.
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Winzeck, S.
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Younsi, A.
Zeiler, F. A.
Ziverte, A.
Zoerle, T.
The CENTER-TBI ICU Participants and Investigators
More authors (159 more) Less
Language :
English
Title :
Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study
Publication date :
2020
Journal title :
Intensive Care Medicine
ISSN :
0342-4642
eISSN :
1432-1238
Publisher :
Springer
Volume :
46
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
ZNS Hannelore Kohl Stiftung
One Mind
Integra LifeSciences
Available on ORBi :
since 06 August 2020

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