Effect of Early Tracheostomy on Mortality of Mechanically Ventilated Patients with Guillain–Barré Syndrome: A Nationwide Observational Study

Abstract

Background: Patients with Guillain-Barré syndrome (GBS) who require mechanical ventilation (MV) are regarded as candidates for early tracheostomy because of the high risk of prolonged MV; however, the association between early tracheostomy and favorable outcomes in patients with GBS remains unclear. In this study, we evaluated the association between early tracheostomy and outcomes in mechanically ventilated patients with GBS.Methods: This retrospective observational study included adult patients with GBS identified in the Japanese Diagnosis Procedure Combination national inpatient database from July 1, 2010, to March 31, 2018, who initiated MV within the first week of admission and who received MV for more than 1 week. Early tracheostomy was defined as tracheostomy performed within 7 days of MV. The primary outcome was in-hospital mortality, and the secondary outcomes were 28-day mortality, nosocomial pneumonia, length of hospital stay, length of intensive care unit (ICU) stay, duration of MV, duration of sedation, duration of analgesia, duration of delirium, and total hospitalization costs. Propensity scores for early tracheostomy were calculated using a logistic regression model on the following variables: age; sex; body mass index; Japan Coma Scale status at admission; Charlson comorbidity index score; comorbidity of chronic pulmonary disease; complication of pneumonia at admission; complication of hyponatremia at admission; neurological presentation at admission; ambulance use; referral from other hospitals; treatment year; days from hospital admission to MV initiation; ICU admission until the day of MV initiation; and treatments until the day of MV initiation. Stabilized inverse probability of treatment weighting analyses was performed to compare the outcomes between patients with and without early tracheostomy.Results: Among 919 eligible patients, 654 patients (71%) underwent tracheostomy, with 136 patients (15%) receiving early tracheostomy. Overall, the median time from initiation of MV to tracheostomy was 12 days (interquartile range 8-15 days). After stabilized inverse probability of treatment weighting, early tracheostomy was not associated with lower in-hospital mortality (risk difference 0.4%; 95% confidence interval − 5.6 to 6.7%) compared with patients without early tracheostomy. There were no significant differences in 28-day mortality (risk difference − 1.3%; 95% confidence interval − 3.5 to 0.9%) and incidence of nosocomial pneumonia (risk difference − 2.6%; 95% confidence

Early Tracheostomy May Reduce the Length of Hospital Stay

“…These data partially corroborate the literature since studies report the benefits of early tracheostomy, regardless of the difference in the scores presented between the studied groups [ 14 – 16 ]. When evaluating the difference in hospital outcomes, no differences were found in hospital mortality between the groups and submitting the patient to early tracheostomy did not influence the hospital survival outcome [ 17 – 19 ]. Despite mortality being an outcome of great importance in clinical practice and the lack of difference between the early and late groups, the benefits of early tracheostomy should still be considered at the time of clinical decision, since it is necessary to evaluate health costs when variables such as days spent in the ICU and in the hospital are analyzed.…”

Improving Outcome in Severe Myasthenia Gravis and Guillain–Barré Syndrome

“…Yet, early tracheostomy does not seem to improve morbidity or mortality in this population. 58 A minority of GBS patients require prolonged mechanical ventilation for more than 2 months. This group is characterized by more severe disability, frequent bulbar involvement, and no excitable nerves on VCS at nadir.…”