Tracheostomy after Severe Ischemic Stroke: A Population-based Study

Abstract

Goal Stroke can result in varying degrees of respiratory failure. Some patients require tracheostomy in order to facilitate weaning from mechanical ventilation, long-term airway protection, or a combination of the two. Little is known about the rate and predictors of this outcome in patients with severe stroke. We aim to determine the rate of tracheostomy after severe ischemic stroke. Materials & Methods Using the Nationwide Inpatient Sample database from 2007–2009, patients hospitalized with ischemic stroke were identified based on validated International Classification of Diseases, 9th Revision, Clinical Modification codes. Next, patients with stroke were stratified based on whether they were treated with or without decompressive craniectomy, and the rate of tracheostomy for each group was determined. A logistic regression analysis was used to identify predictors of tracheostomy after decompressive craniectomy. Survey weights were used to obtain nationally representative estimates. Findings In 1,550,000 patients discharged with ischemic stroke nationwide, the rate of tracheostomy was 1.3% (95% CI, 1.2–1.4%), with a 1.3% (95% CI, 1.1–1.4%) rate in patients without decompressive craniectomy and a 33% (95% CI, 26–39%) rate in the surgical-treatment group. Logistic regression analysis identified pneumonia as being significantly associated with tracheostomy after decompressive craniectomy (OR 3.95; 95% CI 1.95–6.91). Conclusion Tracheostomy is common following decompressive craniectomy and is strongly associated with the development of pneumonia. Given its impact on patient function and potentially modifiable associated factors, tracheostomy may warrant further study as an important patient-centered outcome among patients with stroke.

Rates and Trends of Endotracheal Intubation in Patients With Status Epilepticus

“…As a secondary outcome, we evaluated trends in the use of tracheostomy, as defined by ICD-9-CM procedure codes 31.1, 31.2, 31.21, and 31.29. [17][18][19]…”

Increase of Substance P Concentration in Saliva after Pharyngeal Electrical Stimulation in Severely Dysphagic Stroke Patients – an Indicator of Decannulation Success?

“…Patients with post-stroke dysphagia have a three-times higher risk to develop pneumonia; if aspiration can be detected, the risk rises up to 11.5-times higher [4]. 1.3 – 7.1% of all stroke patients are tracheotomized [8, 9] due to severe dysphagia with prolonged insufficient airway protection or the need for long-term ventilation [10]. The tracheostomy rate of stroke patients on the intensive care unit (ICU) is even higher and ranges between 14 – 35%, exceeding the tracheostomy rates of mixed ICU patient collectives which lie at 10 – 15% [10-12].…”

Critical Care Management of Acute Ischemic Stroke

“…While the overall rate of tracheostomy following stroke is low, it can be required in up to a third of patients with large stroke who require hemicraniectomy [17]. Optimal timing of tracheostomy is not clear, and is the subject of ongoing studies [18, 19].…”