Skip to main content
SpringerLink
Log in

Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury: A US Nationwide Analysis

  • Original work
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

One of the most critical issues in patients suffering from traumatic brain injury (TBI) is protecting the airway and attempting to keep a secure airway. It is evident that tracheostomy in patients with TBI after 7–14 days can have favorable outcomes if the patient cannot be extubated; however, some clinicians have recommended early tracheostomy before 7 days.

Methods

A retrospective cohort of inpatient study participants was queried from the National Inpatient Sample to include patients with TBI between 2016 and 2020 undergoing tracheostomy and outcomes between the two groups of early tracheostomy (ET) (< 7 days from admission) and late tracheostomy (LT) (≥ 7 days from admission) were compared.

Results

We reviewed 219,005 patients with TBI, out of whom 3.04% had a tracheostomy. Patients in the ET group were younger than those in the LT group (45.02 ± 19.38 years old vs. 48.68 ± 20.50 years old, respectively, p < 0.001), mainly men (76.64% vs. 73.73%, respectively, p = 0.01), and mainly White race (59.88% vs. 57.53%, respectively, p = 0.33). The patients in the ET group had a significantly shorter length of stay as compared with those in the LT group (27.78 ± 25.96 days vs. 36.32 ± 29.30 days, respectively, p < 0.001) and had a significantly lower hospital charge ($502,502.436 ± 427,060.81 vs. $642,739.302 ± 516,078.94 per patient, respectively, p < 0.001). The whole TBI cohort mortality was reported at 7.04%, which was higher within the ET group compared with the LT group (8.69% vs. 6.07%, respectively, p < 0.001). Patients in the LT had higher odds of developing any infection (odds ratio [OR] 1.43 [1.22–1.68], p < 0.001), emerging sepsis (OR 1.61 [1.39–1.87], p < 0.001), pneumonia (OR 1.52 [1.36–1.69], p < 0.001), and respiratory failure (OR 1.30 [1.09–1.55], p = 0.004).

Conclusions

This study shows that ET can provide notable and significant benefits for patients with TBI. Future high-quality prospective studies should be performed to investigate and shed more light on the ideal timing of tracheostomy in patients with TBI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. de Franca SA, et al. Early tracheostomy in severe traumatic brain injury patients: a meta-analysis and comparison with late tracheostomy. Crit Care Med. 2020;48(4):e325–31.

    Article  PubMed  Google Scholar 

  2. Khalili H, et al. Experience with traumatic brain injury: is early tracheostomy associated with better prognosis? World Neurosurg. 2017;103:88–93.

    Article  PubMed  Google Scholar 

  3. Wiles MD. Management of traumatic brain injury: a narrative review of current evidence. Anaesthesia. 2022;77(Suppl 1):102–12.

    Article  PubMed  Google Scholar 

  4. Lu Q, et al. Is early tracheostomy better for severe traumatic brain injury? A meta-analysis. World Neurosurg. 2018;112:e324–30.

    Article  PubMed  Google Scholar 

  5. Catalino MP, et al. Early versus late tracheostomy after decompressive craniectomy for stroke. J Intensive Care. 2018;6(1):1–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Young D, et al. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013;309(20):2121–9.

    Article  CAS  PubMed  Google Scholar 

  7. Marra A, et al. Early vs. late tracheostomy in patients with traumatic brain injury: systematic review and meta-analysis. J Clin Med. 2021;10(15):3319.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mubashir T, et al. Effect of tracheostomy timing on outcomes in patients with traumatic brain injury. Proc (Bayl Univ Med Cent). 2022;35(5):621–8.

    PubMed  Google Scholar 

  9. McCredie VA, et al. Effect of early versus late tracheostomy or prolonged intubation in critically ill patients with acute brain injury: a systematic review and meta-analysis. Neurocrit Care. 2017;26(1):14–25.

    Article  PubMed  Google Scholar 

  10. Sutt AL, Fraser JF. Early versus late tracheostomy: what do patients want? Crit Care. 2023;27(1):151.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Premraj L, et al. Tracheostomy timing and outcome in critically ill patients with stroke: a meta-analysis and meta-regression. Crit Care. 2023;27(1):132.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mc Mahon A, et al. Patient-centred outcomes following tracheostomy in critical care. J Intensive Care Med, 2023: p. 8850666231160669.

  13. Sutt AL, et al. Earlier tracheostomy is associated with an earlier return to walking, talking, and eating. Aust Crit Care. 2020;33(3):213–8.

    Article  PubMed  Google Scholar 

  14. HCUP-US NIS Overview. 2021 Accessed August 28, 2021]; Available from: https://www.hcup-us.ahrq.gov/nisoverview.jsp.

  15. Murasaki M, et al. Absence of calvarial fracture could predict the need for tracheostomy in traumatic brain injury. Acute Med Surg. 2021;8(1): e640.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Robba C, et al. Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study. Intensive Care Med. 2020;46(5):983–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Humble SS, et al. Tracheostomy risk factors and outcomes after severe traumatic brain injury. Brain Inj. 2016;30(13–14):1642–7.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc. 2006;54(10):1590–5.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Maiden MJ, et al. Long-term outcomes after severe traumatic brain injury in older adults. A registry-based cohort study. Am J Respir Crit Care Med. 2020;201(2):167–77.

    Article  PubMed  Google Scholar 

  20. Jenkins R, et al. Inpatient complications predict tracheostomy better than admission variables after traumatic brain injury. Neurocrit Care. 2019;30(2):387–93.

    Article  PubMed  Google Scholar 

  21. Selvakumar S, et al. Timing of tracheostomy in patients with severe traumatic brain injuries: the need for tailored practice management guidelines. Injury. 2022;53(8):2717–24.

    Article  PubMed  Google Scholar 

  22. Ismail MI, et al. Comparing the outcomes of early and late tracheostomy in severe traumatic brain injury patient. Malays J Med Sci. 2021;28(4):63–70.

    PubMed  PubMed Central  Google Scholar 

  23. Goo ZQ, Muthusamy KA. Early versus standard tracheostomy in ventilated patients in neurosurgical intensive care unit: a randomized controlled trial. J Clin Neurosci. 2022;98:162–7.

    Article  PubMed  Google Scholar 

  24. Shibahashi K, et al. The effect of tracheostomy performed within 72 h after traumatic brain injury. Br J Neurosurg. 2017;31(5):564–8.

    Article  PubMed  Google Scholar 

  25. Li Z, et al. Tracheostomy as a risk factor for paroxysmal sympathetic hyperactivity in severe traumatic brain injury. World Neurosurg. 2019;123:e156–61.

    Article  PubMed  Google Scholar 

  26. Jafari AA, et al. Paroxysmal sympathetic hyperactivity during traumatic brain injury. Clin Neurol Neurosurg. 2022;212: 107081.

    Article  PubMed  Google Scholar 

  27. Markwart R, et al. Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis. Intensive Care Med. 2020;46(8):1536–51.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zheng R, et al. The association of coagulation indicators with in-hospital mortality and 1-year mortality of patients with sepsis at ICU admissions: a retrospective cohort study. Clin Chim Acta. 2020;504:109–18.

    Article  CAS  PubMed  Google Scholar 

  29. Baron DM, et al. Tracheostomy is associated with decreased hospital mortality after moderate or severe isolated traumatic brain injury. Wien Klin Wochenschr. 2016;128(11–12):397–403.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Siddiqui UT, et al. Clinical outcome and cost effectiveness of early tracheostomy in isolated severe head injury patients. Surg Neurol Int. 2015;6:65.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lu W, et al. Timing of tracheotomy in patients with severe traumatic brain injury. J Craniofac Surg. 2019;30(7):2168–70.

    Article  PubMed  Google Scholar 

  32. Ahmed N, Kuo YH. Early versus late tracheostomy in patients with severe traumatic head injury. Surg Infect (Larchmt). 2007;8(3):343–7.

    Article  PubMed  Google Scholar 

  33. van Dijck J, et al. In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment. PLoS ONE. 2019;14(5): e0216743.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Authors and Affiliations

  1. Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran

    Amirhossein Azari Jafari & Seyyedmohammadsadeq Mirmoeeni

  2. School of Medicine, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA

    David Momtaz, Travis Kotzur & Hari Krishnakumar

  3. Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA

    Gregory Murtha, Carlos Garcia, Maggie Moran, Paola Martinez, Kevin Chen & Ali Seifi

Authors
  1. Amirhossein Azari Jafari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seyyedmohammadsadeq Mirmoeeni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Momtaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Travis Kotzur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gregory Murtha
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carlos Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maggie Moran
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Paola Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kevin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hari Krishnakumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ali Seifi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AAJ: literature review, writing the primary manuscript. SM: literature review, writing the primary manuscript. DM: data analysis, writing the manuscript. TK: data analysis, editing the manuscript. GM: literature review, writing the primary manuscript. CG: literature review, editing the manuscript. MM: literature review, editing the manuscript. PM: editing the manuscript. KC: editing the manuscript. HK: editing the manuscript. AS: principal investigator, designing the project, original idea, writing the final manuscript. The final manuscript was approved by all authors.

Corresponding author

Correspondence to Ali Seifi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval/Informed Consent

We confirm adherence to ethical guidelines and indicate ethical approvals (institutional review board) and use of informed consent, as appropriate.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azari Jafari, A., Mirmoeeni, S., Momtaz, D. et al. Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury: A US Nationwide Analysis. Neurocrit Care 40, 551–561 (2024). https://doi.org/10.1007/s12028-023-01778-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-023-01778-2

Keywords

Search

Navigation