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 :
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
Åkerlund, C.
Amrein, K.
Andelic, N.
Andreassen, L.
Anke, A.
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Bellander, B.-M.
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Beretta, L.
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Brorsson, C.
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Cameron, P.
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De Keyser, Véronique ;  Université de Liège - ULiège > Département de Psychologie > Département de Psychologie
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Frisvold, S.
Furmanov, A.
Galanaud, D.
Gantner, D.
Ghuysen, Alexandre ;  Université de Liège - ULiège > Département des sciences de la santé publique > Simulation médicale en situation critique
Giga, L.
Golubovic, J.
Gomez, P. A.
Grossi, F.
Gupta, D.
Haitsma, I.
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Kowark, A.
Lagares, A.
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
Maas, A. I. R.
Manara, A.
Martino, C.
Maréchal, H.
Mattern, J.
McMahon, C.
Menovsky, T.
Mulazzi, D.
Muraleedharan, V.
Murray, L.
Nair, N.
Negru, A.
Nelson, D.
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.
Raj, R.
Rhodes, J.
Richter, S.
Rocka, S.
Roe, C.
Roise, O.
Rosenfeld, J. V.
Rosenlund, C.
Rosenthal, G.
Rossaint, R.
Rossi, S.
Sahuquillo, J.
Sandro, O.
Sakowitz, O.
Sanchez-Porras, R.
Schirmer-Mikalsen, K.
Schou, R. F.
Smielewski, P.
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Stamatakis, E.
Steyerberg, E. W.
Sundström, N.
Takala, R.
Tamás, V.
Tamosuitis, T.
Tenovuo, O.
Thomas, M.
Tibboe, D.
Tolias, C.
Trapani, T.
Tudora, C. M.
Vajkoczy, P.
Vallance, S.
Valeinis, E.
Vámos, Z.
Van der Steen, G.
van Dijck, J. T. J. M.
van Essen, T. A.
van Wijk, R. P. J.
Vargiolu, A.
Vega, E.
Vik, A.
Vilcinis, R.
Volovici, V.
Voormolen, D.
Vulekovic, P.
Williams, G.
Winzeck, S.
Wolf, S.
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 [DE]
One Mind [US-WA] [US-WA]
Integra LifeSciences [US-NJ] [US-NJ]
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since 06 August 2020

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