Time to tracheostomy impacts overall outcomes in patients with cervical spinal cord injury.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
entrez:
4
8
2020
pubmed:
4
8
2020
medline:
28
10
2020
Statut:
ppublish
Résumé
The morbidity associated with cervical spine injury increases in the setting of concomitant cervical spinal cord injury (CSCI). A significant proportion of these patients require placement of a tracheostomy. However, it remains unclear if timing to tracheostomy following traumatic CSCI can impact outcomes. The aim of our study was to characterize outcomes associated with tracheostomy timing following traumatic CSCI. We performed a 5-year (2010-2014) analysis of the American College of Surgeons Trauma Quality Improvement Program database and included all adult (age, ≥18 years) trauma patients who had traumatic CSCI and received tracheostomy. Patients were subdivided into two groups: early tracheostomy (ET) (≤4 days from initial intubation) and late tracheostomy (LT) (>4 days). Outcome measures included respiratory complications, ventilator-free days, intensive care unit-free days and hospital length of stay, and mortality. Multivariate logistic regression analysis was performed. A total of 5,980 patients were included in the study, of which 1,010 (17%) patients received ET, while 4,970 (83%) patients received LT. Mean age was 46 years, and 73% were men. In terms of CSCI location, 48% of the patients had high CSCI (C1-C4), while 52% had low CSCI (C5-C7). Patients in the ET group had lower rates of respiratory complications (30% vs. 46%, p = 0.01), higher ventilator-free days (13 days vs. 9 days; p = 0.02), intensive care unit-free days (11 days vs. 8 days; p = 0.01), and a shorter hospital length of stay (22 days vs. 29 days; p = 0.01) compared with those in the LT group. On regression analysis, ET was associated with lower rates of respiratory complications in patients with high CSCI (odds ratio, 0.55 [0.41-0.81]) and low CSCI (odds ratio, 0.93 [0.72-0.95]). However, no association was found between time to tracheostomy and in-hospital mortality. Early tracheostomy regardless of CSCI level may lead to improved outcomes. Quality improvement efforts should focus on defining the optimal time to tracheostomy and considering ET as a component of SCI management bundle. Therapeutic, level IV.
Sections du résumé
BACKGROUND
The morbidity associated with cervical spine injury increases in the setting of concomitant cervical spinal cord injury (CSCI). A significant proportion of these patients require placement of a tracheostomy. However, it remains unclear if timing to tracheostomy following traumatic CSCI can impact outcomes. The aim of our study was to characterize outcomes associated with tracheostomy timing following traumatic CSCI.
METHODS
We performed a 5-year (2010-2014) analysis of the American College of Surgeons Trauma Quality Improvement Program database and included all adult (age, ≥18 years) trauma patients who had traumatic CSCI and received tracheostomy. Patients were subdivided into two groups: early tracheostomy (ET) (≤4 days from initial intubation) and late tracheostomy (LT) (>4 days). Outcome measures included respiratory complications, ventilator-free days, intensive care unit-free days and hospital length of stay, and mortality. Multivariate logistic regression analysis was performed.
RESULTS
A total of 5,980 patients were included in the study, of which 1,010 (17%) patients received ET, while 4,970 (83%) patients received LT. Mean age was 46 years, and 73% were men. In terms of CSCI location, 48% of the patients had high CSCI (C1-C4), while 52% had low CSCI (C5-C7). Patients in the ET group had lower rates of respiratory complications (30% vs. 46%, p = 0.01), higher ventilator-free days (13 days vs. 9 days; p = 0.02), intensive care unit-free days (11 days vs. 8 days; p = 0.01), and a shorter hospital length of stay (22 days vs. 29 days; p = 0.01) compared with those in the LT group. On regression analysis, ET was associated with lower rates of respiratory complications in patients with high CSCI (odds ratio, 0.55 [0.41-0.81]) and low CSCI (odds ratio, 0.93 [0.72-0.95]). However, no association was found between time to tracheostomy and in-hospital mortality.
CONCLUSION
Early tracheostomy regardless of CSCI level may lead to improved outcomes. Quality improvement efforts should focus on defining the optimal time to tracheostomy and considering ET as a component of SCI management bundle.
LEVEL OF EVIDENCE
Therapeutic, level IV.
Identifiants
pubmed: 32744832
doi: 10.1097/TA.0000000000002758
pii: 01586154-202008000-00015
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
358-364Références
Branco BC, Plurad D, Green DJ, Inaba K, Lam L, Cestero R, Bukur M, Demetriades D. Incidence and clinical predictors for tracheostomy after cervical spinal cord injury: a National Trauma Databank review. J Trauma. 2011;70(1):111–115.
Center NSCIS. Spinal Cord Injury Facts and Figures at a Glance Birmingham, AL University of Alabama; 2019 [cited 2019 July 8, 2019]. Available from: https://www.nscisc.uab.edu/Public/Facts%20and%20Figures%202019%20-%20Final.pdf. Accessed: 06-12-2019.
Winslow C, Rozovsky J. Effect of spinal cord injury on the respiratory system. Am J Phys Med Rehabil. 2003;82(10):803–814.
Zakrasek EC, Nielson JL, Kosarchuk JJ, Crew JD, Ferguson AR, Mckenna SL. Pulmonary outcomes following specialized respiratory management for acute cervical spinal cord injury: a retrospective analysis. Spinal Cord. 2017;55(6):559–565.
Berlowitz DJ, Wadsworth B, Ross J. Respiratory problems and management in people with spinal cord injury. Breathe. 2016;12(4):328–340.
Flanagan DC, Childs RB, Moore AT, Vallier AH. Early tracheostomy in patients with traumatic cervical spinal cord injury appears safe and may improve outcomes. Spine. 2018;43(16):1110–1116.
Fernandez-Bussy S, Mahajan B, Folch E, Caviedes I, Guerrero J, Majid A. Tracheostomy tube placement: early and late complications. J Bronch Interven Pulmonol. 2015;22(4):357–364.
Elkbuli A, Narvel RI, Spano PJ, Polcz V, Casin A, Hai S, Boneva D, McKenney M. Early versus late tracheostomy: is there an outcome difference? Am Surg. 2019;85(4):370–375.
Scantling D, Granche J, Williamson J, Gracely E, Thosani D, McCracken B. Development of clinical tracheostomy score to identify cervical spinal cord injury patients requiring prolonged ventilator support. J Trauma Acute Care Surg. 2019;87(1):195–199.
Wang Y, Guo Z, Fan D, Lu H, Xie D, Zhang D, Jiang Y, Li P, Teng H. A meta-analysis of the influencing factors for tracheostomy after cervical spinal cord injury. Biomed Res Int. 2018;2018:5895830.
Lee DS, Park CM, Carriere KC, Ahn J. Classification and regression tree model for predicting tracheostomy in patients with traumatic cervical spinal cord injury. Eur Spine J. 2017;26(9):2333–2339.
Tanaka J, Yugue I, Shiba K, Maeyama A, Naito M. A study of risk factors for tracheostomy in patients with a cervical spinal cord injury. Spine. 2016;41(9):764–771.
Jones TS, Burlew CC, Johnson JL, Jones E, Kornblith LZ, Biffl WL, Stovall RT, Pieracci FM, Stahel PF, Moore EE. Predictors of the necessity for early tracheostomy in patients with acute cervical spinal cord injury: a 15-year experience. Am J Surg. 2015;209(2):363–368.
Hou YF, Lv Y, Zhou F, Tian Y, Ji HQ, Zhang ZS, Guo Y. Development and validation of a risk prediction model for tracheostomy in acute traumatic cervical spinal cord injury patients. Eur Spine J. 2015;24(5):975–984.
Childs BR, Moore TA, Como JJ, Vallier HA. American Spinal Injury Association Impairment Scale predicts the need for tracheostomy after cervical spinal cord injury. Spine. 2015;40(18):1407–1413.
Menaker J, Kufera JA, Glaser J, Stein DM, Scalea TM. Admission ASIA motor score predicting the need for tracheostomy after cervical spinal cord injury. J Trauma Acute Care Surg. 2013;75(4):629–634.
Zheng Y, Sui F, Chen XK, Zhang GC, Wang XW, Zhao S, Song Y, Liu W, Xin X, Li WX. Early versus late percutaneous dilational tracheostomy in critically ill patients anticipated requiring prolonged mechanical ventilation. Chin Med J (Engl). 2012;125(11):1925–1930.
Beom JY, Seo HY. The need for early tracheostomy in patients with traumatic cervical cord injury. Clin Orthop Surg. 2018;10(2):191–196.
Guirgis AH, Menon VK, Suri N, Chatterjee N, Attallah E, Saad MY, Elshaer S. Early versus late tracheostomy for patients with high and low cervical spinal cord injuries. Sultan Qaboos Univ Med J. 2016;16(4):e458–e463.
Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ. 2005;330(7502):1243.
Liu CC, Livingstone D, Dixon E, Dort JC. Early versus late tracheostomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015;152(2):219–227.
Romero Vázquez AM, García Rodríguez O, Ramos Meléndez E, Rodríguez Ortiz P. Patient outcomes after early versus late tracheostomy in the Puerto Rico Trauma Hospital. J Patient Saf. 2016;1.
Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, Miletto A, Mangione S, Sinardi AU, Pastorelli M. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010;303(15):1483–1489.
Shirawi N, Arabi Y. Bench-to-bedside review: early tracheostomy in critically ill trauma patients. Crit Care. 2005;10(1):201.
Durbin CG. Indications for and timing of tracheostomy. Respir Care. 2005;50(4):483–487.
Mahafza T, Batarseh S, Bsoul N, Massad E, Qudaisat I, Al-Layla AE. Early vs. late tracheostomy for the ICU patients: experience in a referral hospital. Saudi J Anesth. 2012;6(2):152–154.
O'Keeffe T, Goldman RK, Mayberry JC, Rehm CG, Hart RA. Tracheostomy after anterior cervical spine fixation. J Trauma Acute Care Surg. 2004;57(4):855–860.