Neuroanesthesia & neurocritical care
Tracheostomy versus prolonged intubation in moderate to severe traumatic brain injury: a multicentre retrospective cohort study
Main finding · 30-day mortalityResult — go to the resultAdjusted hazard ratio 0.33 95% CI 0.21–0.53Authors' conclusion
In this multicentre cohort study, tracheostomy was associated with decreased mortality when compared with prolonged endotracheal intubation in patients with moderate to severe TBI. This effect does not appear to be modified by the timing of the procedure.
Study context
- Population
- Adults (≥16 yr) with moderate to severe traumatic brain injury (TBI) (GCS < 13) requiring mechanical ventilation ≥96 hr, Québec Trauma Registry, 2013–2019
- Participants
- 983 adults
- Exposure
- Tracheostomy vs prolonged endotracheal intubation
- Tracheostomyn = 374
- Prolonged endotracheal intubationn = 609reference
- Outcome
- 30-day mortality
- Follow-up
- 30 days
Methodological detailsmulticentre, propensity score covariate adjustment, extended Cox shared frailty model
- Multicentre
- Propensity score covariate adjustment
- Extended Cox shared frailty model
Main finding
As reported in the abstract
Adjusted hazard ratio
0.33
95% CI 0.21–0.53
Tracheostomy vs Prolonged endotracheal intubation
aHR 0.33 (95% CI 0.21–0.53)
Observational data: associations, not effects.
Secondary outcomes
Intensive care unit (ICU) and six-month mortality
- Mortality reduction with tracheostomy also seen in the ICU and at six months
Duration of mechanical ventilation and LOS
- Tracheostomy associated with longer duration of mechanical respiratory assistance without any increase in LOS
Early vs late tracheostomy (timing)
- No effect on mortality of early vs late tracheostomy
- Early procedure associated with shorter mechanical respiratory support and shorter hospital and ICU LOS
Original publication
Tracheostomy versus prolonged intubation in moderate to severe traumatic brain injury: a multicentre retrospective cohort study. Can J Anaesth. Published 28 July 2023. doi:10.
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