Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran.
School of Medicine, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA.
Neurocrit Care. 2024 Apr;40(2):551-561. doi: 10.1007/s12028-023-01778-2. Epub 2023 Jul 6.
One of the most critical issues in patients suffering from traumatic brain injury (TBI) is protecting the airway and attempting to keep a secure airway. It is evident that tracheostomy in patients with TBI after 7-14 days can have favorable outcomes if the patient cannot be extubated; however, some clinicians have recommended early tracheostomy before 7 days.
A retrospective cohort of inpatient study participants was queried from the National Inpatient Sample to include patients with TBI between 2016 and 2020 undergoing tracheostomy and outcomes between the two groups of early tracheostomy (ET) (< 7 days from admission) and late tracheostomy (LT) (≥ 7 days from admission) were compared.
We reviewed 219,005 patients with TBI, out of whom 3.04% had a tracheostomy. Patients in the ET group were younger than those in the LT group (45.02 ± 19.38 years old vs. 48.68 ± 20.50 years old, respectively, p < 0.001), mainly men (76.64% vs. 73.73%, respectively, p = 0.01), and mainly White race (59.88% vs. 57.53%, respectively, p = 0.33). The patients in the ET group had a significantly shorter length of stay as compared with those in the LT group (27.78 ± 25.96 days vs. 36.32 ± 29.30 days, respectively, p < 0.001) and had a significantly lower hospital charge ($502,502.436 ± 427,060.81 vs. $642,739.302 ± 516,078.94 per patient, respectively, p < 0.001). The whole TBI cohort mortality was reported at 7.04%, which was higher within the ET group compared with the LT group (8.69% vs. 6.07%, respectively, p < 0.001). Patients in the LT had higher odds of developing any infection (odds ratio [OR] 1.43 [1.22-1.68], p < 0.001), emerging sepsis (OR 1.61 [1.39-1.87], p < 0.001), pneumonia (OR 1.52 [1.36-1.69], p < 0.001), and respiratory failure (OR 1.30 [1.09-1.55], p = 0.004).
This study shows that ET can provide notable and significant benefits for patients with TBI. Future high-quality prospective studies should be performed to investigate and shed more light on the ideal timing of tracheostomy in patients with TBI.
颅脑创伤（TBI）患者最关键的问题之一是保护气道并保持安全的气道。如果患者不能拔管，TBI 患者在 7-14 天后行气管切开术可获得良好的结果，这是显而易见的；然而，一些临床医生建议在 7 天前进行早期气管切开术。
从国家住院患者样本中查询了一项关于住院患者的回顾性队列研究，纳入了 2016 年至 2020 年期间接受气管切开术的 TBI 患者，并比较了早期气管切开术（ET）（入院后<7 天）和晚期气管切开术（LT）（入院后≥7 天）两组之间的结局。
我们回顾了 219005 例 TBI 患者，其中 3.04%接受了气管切开术。ET 组患者比 LT 组年轻（分别为 45.02±19.38 岁和 48.68±20.50 岁，p<0.001），主要为男性（分别为 76.64%和 73.73%，p=0.01），主要为白人（分别为 59.88%和 57.53%，p=0.33）。与 LT 组相比，ET 组患者的住院时间明显缩短（分别为 27.78±25.96 天和 36.32±29.30 天，p<0.001），住院费用明显降低（分别为 502502.436 美元和 642739.302 美元/人，p<0.001）。整个 TBI 队列的死亡率为 7.04%，ET 组的死亡率高于 LT 组（分别为 8.69%和 6.07%，p<0.001）。LT 组发生任何感染（比值比[OR] 1.43[1.22-1.68]，p<0.001）、脓毒症（OR 1.61[1.39-1.87]，p<0.001）、肺炎（OR 1.52[1.36-1.69]，p<0.001）和呼吸衰竭（OR 1.30[1.09-1.55]，p=0.004）的可能性更高。
本研究表明，ET 可为 TBI 患者提供显著的益处。未来应进行高质量的前瞻性研究，以探讨和进一步阐明 TBI 患者气管切开术的理想时机。
