Tracheostomy After Severe Acute Brain Injury: Trends and Variability in the USA

Abstract

Background/Objective: Severe acute brain injury (SABI) is responsible for 12 million deaths annually, prolonged disability in survivors, and substantial resource utilization. Little guidance exists regarding indication or optimal timing of tracheostomy after SABI. Our aims were to determine national trends in tracheostomy utilization among mechanically ventilated patients with SABI in the USA, as well as to examine factors associated with tracheostomy utilization following SABI. Methods:We conducted a population-based retrospective cohort study using the National Inpatient Sample from 2002 to 2011. We identified adult patients with SABI, defined as a primary diagnosis of stroke, traumatic brain injury or post-cardiac arrest who received mechanical ventilation for greater than 96 h. We analyzed trends in tracheostomy utilization over time and used multilevel mixed-effects logistic regression to analyze factors associated with tracheostomy utilization.Results: There were 94,082 hospitalizations for SABI during the study period, with 30,455 (32%) resulting in tracheostomy utilization. The proportion of patients with SABI who received a tracheostomy increased during the study period, from 28.0% in 2002 to 32.1% in 2011 (p < 0.001). Variation in tracheostomy utilization was noted based on patient and facility characteristics, including higher odds of tracheostomy in large hospitals (OR 1.34, 95% CI 1.18-1.53, p < 0.001, compared to small hospitals), teaching hospitals (OR 1.15, 95% CI 1.06-1.25, p = 0.001, compared to nonteaching hospitals), and urban hospitals (OR 1.60, 95% CI 1.33-1.92, p < 0.001, compared to rural hospitals). Conclusions:Tracheostomy utilization has increased in the USA among patients with SABI, with wide variation by patient and facility-level factors.

Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients – a prospective evaluation

“…Tracheostomy is a frequently performed procedure in the intensive care unit (ICU) [ 13 , 49 ], with 10–15% of patients in polyvalent ICUs [ 1 ] and 15–46.8% in neurocritical care patients [ 21 , 32 ]. In mechanically ventilated patients in the ICU – irrespective of the nature of the underlying disease – tracheostomy is used to prevent laryngeal and tracheal damage, to reduce the need for sedation, to shorten the duration of mechanical ventilation (MV), to increase patient comfort and to reduce the length of stay (LOS) in the ICU [ 13 , 26 , 33 ].…”

Severe pain-related adverse events of percutaneous dilatational tracheostomy performed by a neurointensivist compared with conventional surgical tracheostomy in neurocritically ill patients

“…Therefore, the indication for tracheostomy may be considered to be wider and easier compared with that of the past in patients with acute brain injury. A recent study reported an increase in tracheostomy utilization in the USA among patients with severe acute brain injury [25]. The increasing trend of tracheostomy has arisen from positive reasons such as easy weaning from the ventilator, facilitation of earlier discharge from intensive care, improved patient safety, etc.…”

“…The increasing trend of tracheostomy has arisen from positive reasons such as easy weaning from the ventilator, facilitation of earlier discharge from intensive care, improved patient safety, etc. [25]. Also, tracheostomy and its timing have been hypothesized to be associated with clinical outcomes [26].…”

Practical approach to respiratory emergencies in neurological diseases

“…The incidence of ARF associated with TBI has decreased over the last decade due to improvements in extra-and intrahospital management. However, it still remains one of the main causes of morbidity and mortality, and the incidence of residual respiratory failure at the end of acute hospitalization is approximately 32% [24,25].…”