Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Abstract

BackgroundTo better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study.MethodsThis is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1–2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort.ResultsOf the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1–Q3, 7–21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample.ConclusionsMost patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality.Trial registrationClinicalTrials.gov, NCT02010073. Registered on 12 December 2013.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2126-6) contains supplementary material, which is available to authorized users.

Tracheostomy in patients with acute respiratory distress syndrome is not related to quality of life, symptoms of psychiatric disorders or return-to-work: the prospective DACAPO cohort study

“…For all 1205 patients, the median duration of mechanical ventilation was 16 days (IQR 10-27) and that of ICU length of stay 22 days (IQR 14-36). The median duration of ventilation (20 days [IQR [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] vs. 11 days [IQR 6-16], p < 0.001) and ICU stay (p < 0.001, Table 1) was twice as long for tracheotomised patients. Primary 877 ARDS patients survived and discharged from ICU.…”

“…The TT rate of 55% found in this Germany-wide study seems to be rather high and could be explained by the inclusion of a higher number of patients with severe ARDS. In the worldwide LUNG-SAFE study, only 13% of patients with ARDS had received TT during their length of ICU stay; yet, the rate in European countries was higher at 15.7% [15]. The ICU length of stay was also significantly longer for patients with TT (11 vs. 8 days).…”

“…To date, outcomes' research in TT has focused on clinical outcomes such as ventilator-free days, duration of sedation, length of stay in the ICU, mortality or survival [13][14][15]. Patient-reported outcomes such as HRQoL or patient-reported symptoms of psychiatric disease have not been investigated so far, nor has return-to-work.…”

French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic

“…The indication for tracheostomy and the choice of the technique is a multidisciplinary medical decision made by the anesthesiologist in charge of the patient, in discussion with the ENT surgeon. In the context of the COVID-19 epidemic, the strategy adopted by more and more intensive care units consists in early tracheostomy to wean off intubation in selective patients with severe ARDS and transfer them to a ventilatory weaning unit thus creating room for new patients in ICU [5][6][7].…”

Lung Ultrasound Score Assessing the Pulmonary Edema in Pediatric Acute Respiratory Distress Syndrome Received Continuous Hemofiltration Therapy: A Prospective Observational Study

“…Acute respiratory distress syndrome (ARDS) is characterized by a diffuse in ammatory condition of the lungs, decreased respiratory system compliance, bilateral pulmonary in ltrates and rapid onset of hypoxemic respiratory failure. The hospital mortality of ARDS was still high range from 35% to 46%, according to the report from the LUNG-SAFE study in a convenience sample of 459 in intensive care unit (ICU) from 50 countries (1). Pulmonary edema is one of the main forms of presentation caused by non-cardiogenic factors such as shock, sepsis, pneumonia, and other in ARDS (2).…”