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

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Abe, Toshikazu Madotto, Fabiana Pham, Tài Nagata, Isao Uchida, Masatoshi Wittebole, Xavier [UCL] Berghe, Caroline [UCL] Bulpa, Pierre [UCL] Dive, Alain-Michel [UCL]

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.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2018
Language Anglais
Journal information "Critical care (London, England)" - Vol. 22, no.1, p. 195 [1-16] (2018)
Peer reviewed yes
Publisher BioMed Central Ltd ((United Kingdom) London)
issn 1364-8535
e-issn 1466-609X
Publication status Publié
Affiliations UCL - SSS/IREC/MEDA - Pôle de médecine aiguë
UCL - (SLuc) Service de soins intensifs
UCL - (MGD) Services des soins intensifs
MESH Subject Aged ; Cohort Studies ; Critical Illness ; Female ; Humans ; Intensive Care Units ; Internationality ; Male ; Middle Aged ; Propensity Score ; Prospective Studies ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Severity of Illness Index ; Tracheostomy
Keywords Acute respiratory distress syndrome (ARDS) ; ICU ; Propensity-matched analysis ; Tracheostomy ; Ventilation
Links
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Bibliographic reference Abe, Toshikazu ; Madotto, Fabiana ; Pham, Tài ; Nagata, Isao ; Uchida, Masatoshi ; et. al. Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries.. In: Critical care (London, England), Vol. 22, no.1, p. 195 [1-16] (2018)
Permanent URL http://hdl.handle.net/2078.1/218679