Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries
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...
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| Format: | Article |
| Language: | English |
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BMC
2018-08-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-018-2126-6 |
| _version_ | 1828414757683593216 |
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| author | Toshikazu Abe Fabiana Madotto Tài Pham Isao Nagata Masatoshi Uchida Nanako Tamiya Kiyoyasu Kurahashi Giacomo Bellani John G. Laffey for the LUNG-SAFE Investigators and the ESICM Trials Group |
| author_facet | Toshikazu Abe Fabiana Madotto Tài Pham Isao Nagata Masatoshi Uchida Nanako Tamiya Kiyoyasu Kurahashi Giacomo Bellani John G. Laffey for the LUNG-SAFE Investigators and the ESICM Trials Group |
| author_sort | Toshikazu Abe |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T13:32:10Z |
| format | Article |
| id | doaj.art-3974318bd8b24f16b9183b44880681c9 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-10T13:32:10Z |
| publishDate | 2018-08-01 |
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| series | Critical Care |
| spelling | doaj.art-3974318bd8b24f16b9183b44880681c92022-12-22T01:46:56ZengBMCCritical Care1364-85352018-08-0122111610.1186/s13054-018-2126-6Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countriesToshikazu Abe0Fabiana Madotto1Tài Pham2Isao Nagata3Masatoshi Uchida4Nanako Tamiya5Kiyoyasu Kurahashi6Giacomo Bellani7John G. Laffey8for the LUNG-SAFE Investigators and the ESICM Trials GroupDepartment of General Medicine, Juntendo UniversityResearch Center on Public Health, School of Medicine and Surgery, University of Milano-BicoccaKeenan Research Center for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s HospitalDepartment of Health Services Research, University of TsukubaDepartment of Health Services Research, University of TsukubaDepartment of Health Services Research, University of TsukubaDepartment of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of MedicineDipartimento di Medicina e Chirurgia, Università degli Studi Milano BicoccaKeenan Research Center for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s HospitalAbstract 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.http://link.springer.com/article/10.1186/s13054-018-2126-6TracheostomyAcute respiratory distress syndrome (ARDS)ICUVentilationPropensity-matched analysis |
| spellingShingle | Toshikazu Abe Fabiana Madotto Tài Pham Isao Nagata Masatoshi Uchida Nanako Tamiya Kiyoyasu Kurahashi Giacomo Bellani John G. Laffey for the LUNG-SAFE Investigators and the ESICM Trials Group Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries Critical Care Tracheostomy Acute respiratory distress syndrome (ARDS) ICU Ventilation Propensity-matched analysis |
| title | Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries |
| title_full | Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries |
| title_fullStr | Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries |
| title_full_unstemmed | Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries |
| title_short | Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries |
| title_sort | epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in icus across 50 countries |
| topic | Tracheostomy Acute respiratory distress syndrome (ARDS) ICU Ventilation Propensity-matched analysis |
| url | http://link.springer.com/article/10.1186/s13054-018-2126-6 |
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