Experience with Traumatic Brain Injury: Is Early Tracheostomy Associated with Better Prognosis?

Khalili, Hosseinali; Paydar, Shahram; Safari, Rasool; Arasteh, Peyman; Niakan, Amin; Foroughi, Amin Abolhasani

doi:10.1016/j.wneu.2017.02.060

Cited by 34 publications

(21 citation statements)

References 17 publications

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“…Further, they observed that the scores of GCS and Rotterdam showed no effects on the 6-month prognosis. 23 Two other studies also showed comparable results to the previous study-that patients with ET had a shorter ICU stay compared with LT patients, 20,22 fewer days of MV, shorter duration of hospital stay, and lower incidence of nosocomial pneumonia, 20,22 though mortality rates in ET versus LT were comparable. 22 Alali et al in a cohort of 1,811 patients also observed lower probabilities of pneumonia, deep vein thrombosis, and decubitus ulcers; hospital mortality was similar between groups; unlike the majority, they also evaluated other additional variables with increased possible benefits of ET.…”

Section: Timing Of Tracheostomy: Early Versus Latesupporting

confidence: 60%

“…As in adults, the tracheostomy procedure in pediatrics should be considered if the patients fulfill all the criteria mentioned above, especially if there is an inability to maintain a secure airway, the prolonged ventilation, or even the airway obstruction 45 for this population the tracheostomy timing is between 7 and 10 days. 23 In the pediatric population, the TBI is a major cause of death and disabilities in patients from 1 to 19 years old, 45,46 commonly caused by falls in the youngest patients (< 2 years), while the traffic road motor vehicle accident is the common cause in adolescents. 47 At birth, general requirements are lower and increase at its maximum levels at 9 years of age approximately.…”

Section: Pediatric Perspectivementioning

confidence: 99%

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Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Quiñones-Ossa

Durango-Espinosa

Padilla-Zambrano

et al. 2020

JNRP

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Tracheostomy is the commonest bedside surgical procedure performed on patients needing mechanical ventilation with traumatic brain injury (TBI). The researchers made an effort to organize a narrative review of the indications, timing, management, complications, and outcomes of tracheostomy in relation to neuronal and brain-injured patients following TBI. The study observations were collated from the published literature, namely original articles, book chapters, case series, randomized studies, systematic reviews, and review articles. Information sorting was restricted to tracheostomy and its association with TBI. Care was taken to review the correlation of tracheostomy with clinical correlates including indications, scheduling, interventions, prognosis, and complications of the patients suffering from mild, moderate and severe TBIs using Glasgow Coma Scale, Glasgow Outcome Scale, intraclass correlation coefficient, and other internationally acclaimed outcome scales. Tracheostomy is needed to overcome airway obstruction, prolonged respiratory failure and as indispensable component of mechanical ventilation due to diverse reasons in intensive care unit. Researchers are divided over early tracheostomy or late tracheostomy from days to weeks. The conventional classic surgical technique of tracheostomy has been superseded by percutaneous techniques by being less invasive with lesser complications, classified into early and late complications that may be life threatening. Additional studies have to be conducted to validate and streamline varied observations to frame evidence-based practice for successful weaning and decannulation. Tracheostomy is a safer option in critically ill TBI patients for which a universally accepted protocol for tracheostomy is needed that can help to optimize indications and outcomes.

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Section: Timing Of Tracheostomy: Early Versus Latesupporting

confidence: 60%

Section: Pediatric Perspectivementioning

confidence: 99%

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Quiñones-Ossa

Durango-Espinosa

Padilla-Zambrano

et al. 2020

JNRP

View full text Add to dashboard Cite

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“…This timing of tracheostomy also prevents the use of the procedure in patients with lesser severities of injury, who might achieve successful extubation, and in those who have a rapidly progressive course and succumb early to their injuries. This process of selection still leads to tracheostomy at an earlier stage than commonly observed in non-TBI patients but allows the selection of a cohort most likely susceptible to the potential benefits of the procedure on the patients' outcomes [19,20], by dealing with ongoing failure to protect the airway and the consequent risk of extubation failure [21][22][23][24]. However, the approach to tracheostomy was by no means uniform across ICUs that contributed to CENTER-TBI.…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study

et al. 2020

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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.

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“…The optimal timing of tracheostomy is controversial and varies from 7 to 10 days or even less in adults (3 days). [34,35] In pediatric series the cannulation timing is reported to be 10±8 days (0-38 days) for post-injury events; the decision of cannulation may be shortened to four days and early timing is associated with shorter intubation period, PICU admission and hospitalization. [35] Relatively extended duration in our study may be due to reluctance of families towards the procedure.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Mortality in Pediatric Traumatic Brain Injury: Implementations from a Tertiary Pediatric Intensive Care Facility

Ongun

Dursun²

2017

Ulus Travma Acil Cerrahi Derg

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Mortality rate was 12.5%; six patients progressed to brain death with organ donor approvals in five. Initial hypotension, lung contusion, injury severity scores and Rotterdam-CT scores were related with mortality. Rotterdam-CT score was determined as the independent risk factor for mortality; one increment in the score increased the odd of recovery by 20.334 times (%95 CI 1.999-206.879). ISS score was also borderline significant (p=0.052; OR:1.195 %95 CI 0.999-1.430).

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Experience with Traumatic Brain Injury: Is Early Tracheostomy Associated with Better Prognosis?

Cited by 34 publications

References 17 publications

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study

Prediction of Mortality in Pediatric Traumatic Brain Injury: Implementations from a Tertiary Pediatric Intensive Care Facility

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