Early tracheostomy in patients with cervical spine injury reduces morbidity and improves resource utilization

Khan, Muhammad; Prabhakaran, Kartik; Jehan, Faisal; Anderson, Patrice; Con, Jorge; Lombardo, Gary; Rhee, Peter; Latifi, Rifat

doi:10.1016/j.amjsurg.2020.01.054

Cited by 15 publications

(17 citation statements)

References 18 publications

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“…Mostly of the presented mortality rates between LT and ET analysis do not demonstrate statistically significance [113,114,117,119,120,[124][125][126][127][128], which could be a response of ET placement in critical state patients [86]. Hence, no definitive conclusion could be drawn by the absence of mortality significance, as well, patients functional state at discharge could not be assured.…”

Section: The Benefits Of Tracheostomy On Tbimentioning

confidence: 90%

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Benefits of Early Tracheostomy in TBI Patients

França¹,

Tavares²,

Paiva³

et al. 2021

Advancement and New Understanding in Brain Injury

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Severe traumatic brain injury (TBI) patients are constantly submitted to interventions to cope secondary injury and insults. Oxygen therapy is mostly initiated by endotracheal intubation at the scene of the accident. Due to the severity of the trauma, prolonged mechanical ventilation is expected and tracheostomy (TQT) is often indicated. TQT became one of the most common bedside surgical procedure performed in an Intensive Care Unit (ICU). However, discussion regarding the optimal time for TQT placement to improve outcomes of severe TBI patients remains under discussion. This chapter aims to review TBI's physiopathology and enlighten early tracheostomy's role in severe TBI management.

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Section: The Benefits Of Tracheostomy On Tbimentioning

confidence: 90%

“…Likewise, decreased risk of ventilator associated pneumonia was found. Complementary literature comparing early and late tracheostomy (LT) populations demonstrated lower ICU stay [113,[117][118][119][120], lower hospital stay [117,120], lower rates for pneumonia [113,117,119,120] and lower costs [113,117].…”

Section: The Benefits Of Tracheostomy On Tbimentioning

confidence: 99%

Benefits of Early Tracheostomy in TBI Patients

França¹,

Tavares²,

Paiva³

et al. 2021

Advancement and New Understanding in Brain Injury

View full text Add to dashboard Cite

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“…The characteristics of included studies are summarized in Table 1. Studies differed in their de nitions of early and late tracheostomy (Supplemental Appendix 6), although the majority utilized a range of <7 days (from either injury, intubation, or surgery) for early tracheostomy [23][24][25][26][27][28][29][30][31][32][33]. In one study, early and late tracheostomy were de ned as <7 days and >7 days, respectively, but the time point from which tracheostomy was measured was not speci ed [34].…”

Section: Study Characteristics and Methodological Qualitymentioning

confidence: 99%

Timing of tracheostomy in acute traumatic spinal cord injury: a systematic review and meta-analysis

Foran

Taran

Singh

et al. 2021

Preprint

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Background Patients with acute traumatic cervical or high thoracic level spinal cord injury (SCI) typically require mechanical ventilation (MV) during their acute admission. Placement of a tracheostomy is preferred when prolonged weaning from MV is anticipated. However, the optimal timing of tracheostomy placement in patients with acute traumatic SCI remains uncertain. We systematically reviewed the literature to determine the effects of early versus late tracheostomy or prolonged intubation in patients with acute traumatic SCI on important clinical outcomes.Methods Six databases were searched from their inception to January 2020. Conference abstracts from relevant proceedings and the gray literature were searched to identify additional studies. Data was obtained by two independent reviewers to ensure accuracy and completeness. The quality of observational studies was evaluated using the Newcastle Ottawa Scale (NOS).Results Seventeen studies (2,804 patients) met selection criteria, 14 of which were published after 2009. Meta-analysis showed that early tracheostomy was not associated with decreased short-term mortality (risk ratio [RR] 0.84; 95% confidence interval [CI] 0.39 to 1.79; p = 0.65; n = 2,072), but was associated with a reduction in MV duration (mean difference [MD] 13.1 days; 95% CI -6.70 to -21.11; p = 0.0002; n = 855), intensive care unit (ICU) length of stay (MD -10.20 days; 95% CI -4.66 to -15.74; p = 0.0003; n = 855), and hospital length of stay (MD -7.39 days; 95% CI -3.74 to -11.03; p < 0.0001; n = 423). Early tracheostomy was also associated with a decreased incidence of ventilator-associated pneumonia (VAP) and tracheostomy-related complications (RR 0.86; 95% CI 0.75 to 0.98; p = 0.08; n = 2,043 and RR 0.08; 95% CI -0.01 to -0.15; p = 0.02; n = 812 respectively). The majority of studies ranked as good methodologic quality on the NOS. Conclusions Early tracheostomy in patients with acute traumatic SCI may reduce duration of mechanical ventilation, length of ICU stay, and length of hospital stay. Current studies highlight the lack of high-level evidence to guide the optimal timing of tracheostomy in acute traumatic SCI. Future research should seek to understand whether early tracheostomy improves patient comfort, decreases duration of sedation and improves long-term outcomes.PROSPERO registration number: CRD42020162488

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“…In the context of modern respiratory management strategies, promoting early tracheostomy as an important component of future CSCI management and reconsidering the indications for endotracheal intubation are both important and complement each other. A recent retrospective study reported that early tracheostomy (≤7 days) in CSCI was associated with lower incidence of VAP and shorter duration of ventilatory management, ICU stay, and hospitalization [ 14 ]. On the other hand, tracheostomy itself (both early and late) in CSCI is an independent predictor of ventilator dependence, and there are potential disadvantages inherent in empiric tracheostomy without attempting extubation [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Modern invasive airway management in CSCI has accelerated the trend toward early tracheostomy with a minimum of 4 days once intubated [ 15 ], but several previous studies have shown that one of the independent predictors of the need for tracheostomy is intubation in the ED [ 16 , 17 ]. Many previous studies investigating the usefulness of tracheostomy for CSCI have not described the indications for tracheal intubation [ 12 , 14 – 18 ], reminding us that early routine tracheal intubation for motor-complete injury above C5 is taken for granted. However, the potential risk that absolute indications for intubation based on neurological assessment may increase unnecessary empirical tracheostomies and the limitations of clinical studies that may not rigorously assess the role of tracheostomy have not been fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury

et al. 2021

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Background Early routine intubation in motor-complete cervical spinal cord injury (CSCI) above the C5 level is a conventional protocol to prevent unexpected respiratory exacerbation (RE). However, in the context of recent advances in multidisciplinary respiratory management, the absolute indication for intubation in patients with CSCI based on initial neurologic assessment is controversial because of the drawbacks of intubation. This study aimed to redetermine the most important predictor of RE following CSCI after admission without routine intubation among patients admitted with motor-complete injury and/or injury above the C5 level to ensure timely intubation. Methods We performed a retrospective review of patients with acute traumatic CSCI admitted to our hospital without an initial routine intubation protocol from January 2013 to December 2017. CSCI patients who developed RE (defined as unexpected emergent intubation for respiratory resuscitation) were compared with those who did not. Baseline characteristics and severity of trauma data were collected. Univariate analyses were performed to compare treatment data and clinical outcomes between the two groups. Further, multivariate logistic regression was performed with clinically important independent variables: motor-complete injury, neurologic level above C5, atelectasis, and copious airway secretion (CAS). Results Among 58 patients with CSCI, 35 (60.3%) required post-injury intubation and 1 (1.7%) died during hospitalization. Thirteen (22.4%) had RE 3.5 days (mean) post-injury; 3 (37.5%) of eight patients with motor-complete CSCI above C5 developed RE. Eleven of the 27 (40.7%) patients with motor-complete injury and five of the 22 (22.7%) patients with neurologic injury above C5 required emergency intubation at RE. Three of the eight CSCI patients with both risk factors (motor-complete injury above C5) resulted in emergent RE intubation (37.5%). CAS was an independent predictor for RE (odds ratio 7.19, 95% confidence interval 1.48–42.72, P = 0.0144) in multivariate analyses. Conclusion Timely intubation post-CSCI based on close attention to CAS during the acute 3-day phase may prevent RE and reduce unnecessary invasive airway control even without immediate routine intubation in motor-complete injury above C5.

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Early tracheostomy in patients with cervical spine injury reduces morbidity and improves resource utilization

Cited by 15 publications

References 18 publications

Benefits of Early Tracheostomy in TBI Patients

Benefits of Early Tracheostomy in TBI Patients

Timing of tracheostomy in acute traumatic spinal cord injury: a systematic review and meta-analysis

Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury

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