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

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

doi:10.1097/ccm.0000000000001195

Cited by 37 publications

(24 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tracheostomy is usually performed in critically ill patients who require prolonged mechanical ventilation. Tracheostomy has several established advantages over translaryngeal intubation, including reduced airway dead space and thus reduced work of breathing, facilitated weaning from mechanical ventilation, reduced undesired consequences of prolonged mechanical ventilation (e.g., ventilator-associated pneumonia and tracheal stenosis), convenient suctioning, and better patient comfort [3,4]. However, tracheostomy is not risk-free, and the optimal timing to perform tracheostomy remains challenging.…”

Section: Introductionmentioning

confidence: 99%

The impact of tracheostomy timing on clinical outcomes and adverse events in intubated patients with infratentorial lesions: early versus late tracheostomy

Huang

Zhang

et al. 2020

Neurosurg Rev

View full text Add to dashboard Cite

We evaluated the association between the timing of tracheostomy and clinical outcomes in patients with infratentorial lesions. We performed a retrospective observational cohort study in a neurosurgical intensive care unit (ICU) at a tertiary academic medical center from January 2014 to December 2018. Consecutive adult patients admitted to the ICU who underwent resection of infratentorial lesions as well as tracheostomy were included for analysis. Early tracheostomy was defined as performed on postoperative days 1-10 and late tracheostomy on days 10-20 after operation. Univariate and multivariate analyses were used to compare the characteristics and outcomes between both cohorts. A total of 143 patients were identified, and 96 patients received early tracheostomy. Multivariable analysis identified early tracheostomy as an independent variable associated with lower occurrence of pneumonia (odds ratio, 0.25; 95% CI, 0.09-0.73; p = 0.011), shorter stays in ICUs (hazard ratio, 0.4; 95% CI, 0.3-0.6; p = 0.03), and earlier decannulation (hazard ratio, 0.5; 95% CI, 0.4-0.8; p = 0.003). However, no significant differences were observed between the early and late tracheostomy groups regarding hospital mortality (p > 0.999) and the modified Rankin scale after 6 months (p = 0.543). We also identified postoperative brainstem deficits, including cough, swallowing attempts, and extended tongue as well as GCS < 8 at ICU admission as the risk factors independently associated with patients underwent tracheostomy. There is a significant association between early tracheostomy and beneficial clinical outcomes or reduced adverse event occurrence in patients with infratentorial lesions.

show abstract

Section: Introductionmentioning

confidence: 99%

The impact of tracheostomy timing on clinical outcomes and adverse events in intubated patients with infratentorial lesions: early versus late tracheostomy

Huang

Zhang

et al. 2020

Neurosurg Rev

View full text Add to dashboard Cite

show abstract

“…also showed tracheostomy within 7 days of critical care admission for patients with poor-grade subarachnoid hemorrhage was associated with fewer respiratory adverse events. [ 14 ] However, ET had no impact on in-hospital mortality. [ 9 11 12 ] It has been suggested that ET should be recommended in traumatic brain injury patients who have a chance of survival.…”

Section: Introductionmentioning

confidence: 99%

The impact of early tracheostomy in neurotrauma patients: A Retrospective study

Zirpe

Tambe

Deshmukh

et al. 2017

Indian Journal of Critical Care Medicine

View full text Add to dashboard Cite

Background:Although majority of neurotrauma patients require long term ventilatory support but the timing of tracheostomy in such patients is controversial.Method:This retrospective study was conducted at a Tertiary Care Hospital, Pune, India. Patients >18 years of age, who underwent percutaneous tracheostomy (PCT) from June 2010 to November 2014 at neurotrauma unit (NTU) of hospital, were included. Patients were divided in two groups according to the timing of tracheostomy, early tracheostomy (ET) group (≤5 days; N=100) and late tracheostomy (LT) group (>5 days; N=64). The nonparametric Mann-Whitney test, and Chi-square tests were used to compare these groups.Result:There were no significant differences between the groups in terms of age, sex, APACHE II and GCS Score. Patients in the ET group had a significantly shorter stay in the NTU compared to patients in the LT group (mean, 18 vs. 21.2 days, p=0.005), fewer mechanical ventilation days (mean, 8.1 vs. 11.7 days, P=0.000) and shorter length of stay in hospital (mean, 28.8 vs. 34.37 days, P=0.019). There was no difference between ET and LT groups in post PCT ventilator free days (mean, 8.2 vs. 9.4 days; P=0.094). Mortality rates in ET vs. LT groups were also comparable (35% vs. 29.7%; P=0.480).Conclusion:Results suggest that ET in neurotrauma patients might be associated with shorter length of stay in NTU and hospital, and shorter duration of mechanical ventilation however there was no mortality difference.

show abstract

“…Several mostly retrospective data previously published favor early surgical treatment. However, the literature on the optimal treatment of SEA displays various limitations: next to the retrospective nature of most publication, another limitation lies within the lack of a consensus of “early” and “late” procedures, as observed in other neurosurgical diseases [ 13 ]. Connor et al [ 3 ] reported their series consisting of 77 patients using a 3-day cutoff.…”

Section: Discussionmentioning

confidence: 99%

Early versus Delayed Surgery for Spinal Epidural Abscess : Clinical Outcome and Health-Related Quality of Life

Behmanesh

Geßler

Quick-Weller

et al. 2020

J Korean Neurosurg Soc

Self Cite

View full text Add to dashboard Cite

Objective : Spinal epidural abscess (SEA) is a severe and life-threatening disease. Although commonly performed, the effect of timing in surgical treatment on patient outcome is still unclear. With this study, we aim to provide evidence for early surgical treatment in patients with SEA. Methods : Patients treated for SEA in the authors' department between 2007 and 2016 were included for analysis and retrospectively analyzed for basic clinical parameters and outcome. Pre-and postoperative neurological status were assessed using the American Spinal Injury Association Impairment Scale (AIS). The self-reported quality of life (QOL) based on the Short-Form Health Survey 36 (SF-36) was assessed prospectively. Surgery was defined as "early", when performed within 12 hours after admission and "late" when performed thereafter. Conservative therapy was preferred and recommend in patients without neurological deficits and in patients denying surgical intervention. Results : One hundred and twenty-three patients were included in this study. Forty-nine patients (39.8%) underwent early, 47 patients (38.2%) delayed surgery and 27 (21.9%) conservative therapy. No significant differences were observed regarding mean age, sex, diabetes, prior history of spinal infection, and bony destruction. Patients undergoing early surgery revealed a significant better clinical outcome before discharge than patients undergoing late surgery (p=0.001) and conservative therapy. QOL based on SF-36 were significantly better in the early surgery cohort in two of four physical items (physical functioning and bodily pain) and in one of four psychological items (role limitation) after a mean follow-up period of 58 months. Readmission to the hospital and failure of conservative therapy were observed more often in patients undergoing conservative therapy. Conclusion : Our data on both clinical outcome and QOL provide evidence for early surgery within 12 hours after admission in patients with SEA.

show abstract

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

Abstract: Tracheostomy within 7 days of critical care admission is a feasible and safe procedure for patients with poor-grade subarachnoid hemorrhage. Early tracheostomy was not associated with an improvement in mortality or neurologic outcome but associated with fewer respiratory adverse events.

Cited by 37 publications

References 26 publications

The impact of tracheostomy timing on clinical outcomes and adverse events in intubated patients with infratentorial lesions: early versus late tracheostomy

The impact of tracheostomy timing on clinical outcomes and adverse events in intubated patients with infratentorial lesions: early versus late tracheostomy

The impact of early tracheostomy in neurotrauma patients: A Retrospective study

Early versus Delayed Surgery for Spinal Epidural Abscess : Clinical Outcome and Health-Related Quality of Life

Contact Info

Product

Resources

About