Early tracheostomy is associated with better prognosis in patients with brainstem hemorrhage

Abstract

Brainstem hemorrhage is presumed to be invariably associated with a poor prognosis in people with spontaneous hypertensive cerebral hemorrhage. The optimal timing of tracheostomy placement in brainstem hemorrhage patients, who generally require endotracheal intubation for airway protection, remains uncertain. Our research aim was to analyze the impact of early tracheostomy versus late tracheostomy on brainstem hemorrhage patients related outcomes and prognostic factors at 30 days. We identified early tracheostomy and how it could benefit the patients with brainstem hemorrhage and ameliorate the predictors of functional recovery at 30 days. Data on 136 patients with brainstem hemorrhage and Glasgow Coma Scale score ≤ 8, were retrospectively collected from 2012 to 2019. Patients were divided into the early tracheostomy group and the late tracheostomy group. Patients in the early tracheostomy group had a significantly lower neurosurgical intensive care unit stay (both overall and survival) compared with the late tracheostomy group (15.6 days vs. 19.0 days, P = 0.041, overall and 14.5 vs. 19.5 days, P = 0.023, survival). Also, the good outcomes (modified Rankin Score ≤ 3) were higher in the early tracheostomy group (P = 0.036). Multivariate analysis demonstrated that less hemorrhagic volume, high Glasgow Coma Scale score on admission, young age, and early tracheostomy were significantly associated with a better 30-day functional outcome. In conclusion, an early tracheostomy in patients with brainstem hemorrhage can reduce neurosurgical intensive care unit stay, and in addition to improvements in prognosis at 30 days.

A Nomogram for Predicting the Need of Postoperative Tracheostomy in Patients With Aneurysmal Subarachnoid Hemorrhage

“…Chen et al investigated 425 patients with hemorrhagic stroke and concluded that early TT in those patients could reduce hospital costs and hospital stays with no increase in hospital mortality (4). In another study, Ding et al claimed that early TT could improve the prognosis at 30 days in patients with brainstem hemorrhage (5). However, there are few studies focusing on postoperative TT in aSAH patients specifically (24).…”

“…In patients with hemorrhagic stroke, the rates of TT have been found to be significantly higher than in non-neurologic patients (3). Also, several retrospective studies confirmed that the timing of TT could have significant effects in outcomes of patients with hemorrhagic stroke (4,5). Previously, the feasibility, safety, and reduction of sedation need of early TT in ventilated stroke patients have been confirmed in a randomized pilot trial (6).…”

Primary Brainstem Hemorrhage: A Review of Prognostic Factors and Surgical Management

“…However, whether age or sex affects patients with PBSH remains an unresolved problem. Patient age was found to independently affect 30-day mortality or functional outcomes by Morotti et al and Ding et al by multivariate logistic regression analysis (1,22). Intriguingly, no study has demonstrated that sex is a predictor of the outcomes of PBSH.…”

“…Central hyperthermia is a complication after PBSH that is characterized by a core temperature of ≥39 • C and is unresponsive to conventional antipyretic treatments due to an unchanged thermoregulatory setpoint (26)(27)(28). Central hyperthermia was proven to be independently related to death in PPH by Matsukawa et al, but was not identified as an independent predictive factor of 30-day outcomes after PBSH in another study (20,22). Although central hyperthermia associated with PBSH is supposed to be injurious to patients, it remains unknown whether a positive pursuit of a normal body temperature contributes to a more favorable clinical prognosis in the absence of evidence.…”

“…Additionally, patients with severe PBSH present with a high risk of neurological complications and in desperate need of measures to protect the airway, especially within the acute phase. A study revealed that early tracheostomy (≤7 days after admission) was significantly associated with a favorable 30-day functional outcome (prognostic benefits) and was also able to reduce the length of hospitalization and intensive care unit stay (financial benefits) (22). However, there are potential risks that should not be neglected when performing a tracheostomy, such as skin breakdown, tracheomalacia and so on (29).…”