6533b7dcfe1ef96bd12733f8

RESEARCH PRODUCT

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

Abe T.Madotto F.Pham T.Nagata I.Uchida M.Tamiya N.Kurahashi K.Bellani G.Laffey J. 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DrElmasri MIsmail DDreyer KrBlakeman TcGomaa DBaron RmGrijalba CqHou PcSeethala RAisiku IHenderson GFrendl GHou SkOwens RlSchomer ABumbasirevic VJovanovic BSurbatovic MVeljovic M.

subject

MaleARDSInternationality[SDV]Life Sciences [q-bio]humanoslnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4]traqueostomíaCritical Care and Intensive Care MedicineSeverity of Illness IndexCohort StudiesPropensity-matched analysi0302 clinical medicineTracheostomyestudios prospectivosEpidemiologyAcute respiratory distress syndrome (ARDS)030212 general & internal medicineProspective Studiespuntuación de propensión10. No inequalityProspective cohort studyestudios de cohortesmediana edadancianoRespiratory Distress SyndromerespiraciónRespirationlcsh:Medical emergencies. Critical care. Intensive care. First aidMiddle Aged3. Good healthIntensive Care UnitsCohortArtificialCritical IllneFemaleAcute respiratory distress syndrome (ARDS); ICU; Propensity-matched analysis; Tracheostomy; Ventilation; 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; TracheostomyCohort studyHumanAdultmedicine.medical_specialtyCritical IllnessIntensive Care UnitSocio-culturaleunidades de cuidados intensivosenfermedad críticaPropensity-matched analysis03 medical and health sciencesAcute respiratory distress syndrome (ARDS); ICU; Propensity-matched analysis; Tracheostomy; VentilationSeverity of illnessSettore MED/41 - ANESTESIOLOGIAmedicineHumansíndice de gravedad de la enfermedadPropensity ScoreAgedbusiness.industryResearchRespiratory Distress Syndrome Adultinternacionalidadlcsh:RC86-88.9medicine.diseaseR1Respiration ArtificialVentilationProspective Studie030228 respiratory systemPropensity score matchingEmergency medicineICUObservational studyCohort Studiebusiness

description

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.

10.1186/s13054-018-2126-6http://hdl.handle.net/10807/215198