The Impact of Tracheostomy Timing on Clinical Outcome and Adverse Events in Poor-Grade Subarachnoid Hemorrhage

Gessler, F.; Mutlak, Haitham; Lamb, Stefan; Hartwich, M.; Adelmann, Michael; Platz, Johannes; Konczalla, Juergen; Seifert, Volker; Senft, Christian

doi:10.1097/01.sa.0000484861.93236.90

Cited by 3 publications

(9 citation statements)

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“…Factors associated with decannulation included age ≤ 65, absence of vasospasm, tracheostomy ≤ 7 days from admission, absence of sepsis, and supratentorial lesions, whereas stroke severity on admission or presence of chronic obstructive pulmonary disease did not significantly influence decannulation. Decannulated patients had better functional outcomes at one year [17,20].…”

Section: Resultsmentioning

confidence: 92%

“…Long-term functional outcome (Fig. 2a): Five studies (n = 451 patients) reported on the primary outcome of long-term neurological function [17][18][19][20][21], with the following diagnoses: SAH (51.4%), AIS (25.4%), ICH (24.6%), and TBI (4%).…”

Section: Resultsmentioning

confidence: 99%

“…Most studies did not distinguish outcomes between SABI subgroups. One study exclusively investigating patients with SAH [17] reported higher proportions of independence (56%) and very good outcomes (44%) compared the 3 other studies looking at mixed stroke populations (19% and 4%, supplement) [18][19][20]. The only study separating outcomes by subgroup [21] suggested that patients with SAH had the highest rate of independence (66%) and very good outcomes (50%) at 6-12 months, followed by patients with TBI (44% and 28%), ICH (38 and 21%) and AIS (29% and 12%).…”

Section: Resultsmentioning

confidence: 99%

“…Mortality (Fig. 2b): Of the 17 studies (n = 19,048 pts) reporting mortality data [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] all reported hospital mortality, whereas only 6 studies (n = 517) also assessed late mortality [17][18][19][20][21]30]. The pooled hospital mortality was 12%, (95% CI 9-17%), and similar for patients with stroke (10%; 95% CI 4-21%) and TBI (13%; 95% CI 9-18%).…”

Section: Resultsmentioning

confidence: 99%

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Outcomes After Tracheostomy in Patients with Severe Acute Brain Injury: A Systematic Review and Meta-Analysis

et al. 2020

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Objective: To synthesize reported long-term outcomes in patients undergoing tracheostomy after severe acute brain injury (SABI). Methods:We systematically searched PubMed, EMBASE, and Cochrane Library for studies in English, German, and Spanish between 1990 and 2019, reporting outcomes in patients with SABI who underwent tracheostomy. We adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines and the meta-analyses of observational studies in epidemiology guidelines. We excluded studies reporting on less than 10 patients, mixed populations with other neurological diseases, or studies assessing highly select subgroups defined by age or procedures. Data were extracted independently by two investigators. Results were pooled using random effects modeling. The primary outcome was long-term functional outcome (mRS or GOS) at 6-12 months. Secondary outcomes included hospital and long-term mortality, decannulation rates, and discharge home rates.Results: Of 1405 studies identified, 61 underwent full manuscript review and 19 studies comprising 35,362 patients from 10 countries were included in the meta-analysis. The primary outcome was available from five studies with 451 patients. At 6-12 months, about one-third of patients (30%; 95% confidence interval [CI] 17-48) achieved independence, and about one-third survived in a dependent state (36%, 95% CI 28-46%). The pooled short-term mortality for 19,048 patients was 12%, (95% CI 9-17%) with no significant difference between stroke (10%) and TBI patients (13%), and the pooled long-term mortality was 21% (95% CI 11-36). Decannulation occurred in 79% (95% CI 51-93%) of survivors. Heterogeneity was high for most outcome assessments (I 2 > 75%). Conclusions:Our findings suggest that about one in three patients with SABI who undergo tracheostomy may eventually achieve independence. Future research is needed to understand the reasons for the heterogeneity between studies and to identify those patients with promising outcomes as well as factors influencing outcome.

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Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Outcomes After Tracheostomy in Patients with Severe Acute Brain Injury: A Systematic Review and Meta-Analysis

et al. 2020

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“…Others suggested that ET may shorten the duration of sedation (17). In patients with subarachnoid hemorrhage ET was associated with fewer respiratory adverse events (59). Given the conflicting results of current studies, more investigations are needed, with standard definition of timing and homogeneous study population.…”

Section: Resultsmentioning

confidence: 99%

How should this patient with repeated aspiration pneumonia be managed and treated?—a proposal of the Percutaneous ENdoscopIc Gastrostomy and Tracheostomy (PENlIGhT) procedure

et al. 2016

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Cerebrovascular accident (CVA) is commonly seen among the elderly with a substantial proportion of patients suffering from long-term dysphagia and/or an inability to protect their airway. This potentially imposes on them an increased risk of malnutrition and aspiration pneumonia. In this article, we present a patient with malnutrition and dysphagia secondary to CVA. We propose a procedure for which we will name the Percutaneous ENdoscopIc Gastrostomy and Tracheostomy (PENlIGhT) procedure for placement of percutaneous endoscopic gastrostomy (PEG) and tracheostomy tube (TT) at the same time. The medical literature was systematically reviewed for both PEG and tracheostomy, aiming to provide the state-of-the-art evidence for clinical use of the PENlIGhT procedure. In clinical practice, the PENlIGhT procedure is indicated for patients who are expected to have prolonged swallowing disturbance and mechanical ventilation. Some prediction tools and scores can be helpful to identify such groups of patients. Patients with poor neurological outcomes who require prolonged maintenance of life are also good candidates for the PENlIGhT procedure.

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The Impact of Tracheostomy Timing (Early and Late) on Severe Head Injury Patients Toward Clinical Outcomes

Mahmud,

Ludin,

Lee

et al. 2023

Int J Care Scholars

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Introduction: Severe head injury patients require a specific treatment plan and nursing care to achieve an optimal clinical outcome. Mild head injury patients may need a few days of hospitalisation for close monitoring and conservative medical administrations. However, in severe head injury cases, the patients may require a more extended period of hospitalisation for a series of complex neuro-medical and neurosurgical management. Tracheostomy may be performed on head injury patients with protracted breathing problems. Early tracheostomy (ET) may improve clinical outcomes late tracheostomy. ET is defined as the tracheostomy done seven days after the initiation of endotracheal intubation. Objective : The objective of this study is to determine the impact of ET on a patient's clinical outcome before being discharged. Methodology: This is a retrospective cohort study involving 45 severe head injury patients with tracheostomy done in two Neuro-Centre hospitals in Klang Valley. The clinical outcome was observed before the participants are discharged including the participant's GCS upon discharge, length of stay (LOS) in the ICU and hospital, the incidence of VAP, duration of mechanical ventilation dependency, and decannulation rate. Findings: There are 45 participants in this study as the sample. Crude analysis performed in this study showed that there is a significant association between tracheostomy classification (early and late) toward participant length of stay in the ICU with a p-value of <0.001, LOS in the hospital (p=0.002), and duration on the mechanical ventilation use (p<0.001) with no association with the GCS upon discharge (p=0.057), the incidence of VAP (p=0.374), and decannulation rate (p=0.081).Potential confounding factors in this study were determined statistically. It was done by comparing the model without an additional factor and the model with an additional factor. Multivariate analysis showed that the association between these variables remained significant for the LOS in the hospital (p=0.035) and duration of mechanical ventilation used (p=0.005). Conclusion: The initiation of ET contributes to a favourable clinical outcome in terms of the duration of mechanical ventilation and length of hospital stay for patients with a severe head injury. However, the association between tracheostomy categorisation and ICU LOS, incidence of pneumonia, decannulation rate, and GCS at discharge was not statistically significant.

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The Impact of Tracheostomy Timing on Clinical Outcome and Adverse Events in Poor-Grade Subarachnoid Hemorrhage

Cited by 3 publications

References 3 publications

Outcomes After Tracheostomy in Patients with Severe Acute Brain Injury: A Systematic Review and Meta-Analysis

Outcomes After Tracheostomy in Patients with Severe Acute Brain Injury: A Systematic Review and Meta-Analysis

How should this patient with repeated aspiration pneumonia be managed and treated?—a proposal of the Percutaneous ENdoscopIc Gastrostomy and Tracheostomy (PENlIGhT) procedure

The Impact of Tracheostomy Timing (Early and Late) on Severe Head Injury Patients Toward Clinical Outcomes

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