Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Toshikazu Abe, Fabiana Madotto, Tài Pham, Isao Nagata, Masatoshi Uchida, Nanako Tamiya, Kiyoyasu Kurahashi, Giacomo Bellani, John G Laffey, LUNG-SAFE Investigators and the ESICM Trials Group

Abstract

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study.

Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort.

Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample.

Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality.

Trial registration: ClinicalTrials.gov, NCT02010073 . Registered on 12 December 2013.

Keywords: Acute respiratory distress syndrome (ARDS); ICU; Propensity-matched analysis; Tracheostomy; Ventilation.

Conflict of interest statement

Ethics approval and consent to participate

All participating ICUs obtained ethics committee approval and obtained either patient consent or ethics committee waiver of consent in the LUNG-SAFE study. The study protocol was also reviewed and approved by the ethics committee of Mito Kyodo General Hospital, University of Tsukuba Hospital Mito Medical Center, Japan.

Consent for publication

Not applicable.

Competing interests

All authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of study participants. AHRF, acute hypoxic respiratory failure; ARDS, acute respiratory distress syndrome, Pts, patients; COPD, chronic obstructive pulmonary disease
Fig. 2
Fig. 2
Distribution of time to tracheostomy (n = 309)
Fig. 3
Fig. 3
1 Survival probability during the first 28 days. 2 Survival probability during the first 60 days. 3 Survival probability during the first 90 days
Fig. 4
Fig. 4
Distribution of the logit of propensity scores in patients with tracheostomy (n = 267) and without tracheostomy (n = 267) in the matched sample
Fig. 5
Fig. 5
Survival probability during the hospital stay in the matched sample (n = 534). Kaplan Meier’s approach, assuming as censored, those patients discharged and alive before day 90

References

    1. Jaeger JM, Littlewood KA, Durbin CG., Jr The role of tracheostomy in weaning from mechanical ventilation. Respir Care. 2002;47(4):469–480.
    1. Mahmood K, Wahidi MM. The changing role for tracheostomy in patients requiring mechanical ventilation. Clin Chest Med. 2016;37(4):741–751. doi: 10.1016/j.ccm.2016.07.013.
    1. Hosokawa K, Nishimura M, Egi M, Vincent JL. Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care. 2015;19:424. doi: 10.1186/s13054-015-1138-8.
    1. Laffey JG, Bellani G, Pham T, Fan E, Madotto F, Bajwa EK, Brochard L, Clarkson K, Esteban A, Gattinoni L, et al. Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med. 2016;42(12):1865–1876. doi: 10.1007/s00134-016-4571-5.
    1. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800. doi: 10.1001/jama.2016.0291.
    1. Groves DS, Durbin CG., Jr Tracheostomy in the critically ill: indications, timing and techniques. Curr Opin Crit Care. 2007;13(1):90–97. doi: 10.1097/MCC.0b013e328011721e.
    1. Mehta AB, Syeda SN, Bajpayee L, Cooke CR, Walkey AJ, Wiener RS. Trends in tracheostomy for mechanically ventilated patients in the United States, 1993-2012. Am J Respir Crit Care Med. 2015;192(4):446–454. doi: 10.1164/rccm.201502-0239OC.
    1. Siempos II, Ntaidou TK, Filippidis FT, Choi AM. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(2):150–158. doi: 10.1016/S2213-2600(15)00007-7.
    1. Andriolo BN, Andriolo RB, Saconato H, Atallah AN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev. 2015;1:CD007271.
    1. Laffey JG, Madotto F, Bellani G, Pham T, Fan E, Brochard L, Amin P, Arabi Y, Bajwa EK, Bruhn A, et al. Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study. Lancet Respir Med. 2017;5(8):627–638. doi: 10.1016/S2213-2600(17)30213-8.
    1. Young D, Harrison DA, Cuthbertson BH, Rowan K, TracMan C. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013;309(20):2121–2129. doi: 10.1001/jama.2013.5154.
    1. Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014;59(6):895–915. doi: 10.4187/respcare.02971.
    1. Meng L, Wang C, Li J, Zhang J. Early vs late tracheostomy in critically ill patients: a systematic review and meta-analysis. Clin Respir J. 2016;10(6):684–692. doi: 10.1111/crj.12286.
    1. Esteban A, Anzueto A, Alia I, Gordo F, Apezteguia C, Palizas F, Cide D, Goldwaser R, Soto L, Bugedo G, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med. 2000;161(5):1450–1458. doi: 10.1164/ajrccm.161.5.9902018.
    1. Durbin CG., Jr Indications for and timing of tracheostomy. Respir Care. 2005;50(4):483–487.
    1. Ortiz JR, Neuzil KM, Shay DK, Rue TC, Neradilek MB, Zhou H, Seymour CW, Hooper LG, Cheng PY, Goss CH, et al. The burden of influenza-associated critical illness hospitalizations. Crit Care Med. 2014;42(11):2325–2332. doi: 10.1097/CCM.0000000000000545.
    1. Guerin C, Beuret P, Constantin JM, Bellani G, Garcia-Olivares P, Roca O, Meertens JH, Maia PA, Becher T, Peterson J, et al. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS prone position network) study. Intensive Care Med. 2018;44(1):22–37. doi: 10.1007/s00134-017-4996-5.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever