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

LUNG SAFE Investigators, the ESICM Trials Group

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish
Article number195
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - Aug 17 2018

Fingerprint

Tracheostomy
Adult Respiratory Distress Syndrome
Epidemiology
Respiratory Insufficiency
Noninvasive Ventilation
Propensity Score
Survival
Mortality
Critical Illness
Observational Studies
Length of Stay
Cohort Studies

Keywords

  • Acute respiratory distress syndrome (ARDS)
  • ICU
  • Propensity-matched analysis
  • Tracheostomy
  • Ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries. / LUNG SAFE Investigators; the ESICM Trials Group.

In: Critical Care, Vol. 22, No. 1, 195, 17.08.2018.

Research output: Contribution to journalArticle

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title = "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 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.",
keywords = "Acute respiratory distress syndrome (ARDS), ICU, Propensity-matched analysis, Tracheostomy, Ventilation",
author = "{LUNG SAFE Investigators} and {the ESICM Trials Group} and Toshikazu Abe and Fabiana Madotto and T{\`a}i Pham and Isao Nagata and Masatoshi Uchida and Nanako Tamiya and Kiyoyasu Kurahashi and Giacomo Bellani and Laffey, {John G.} and Francois, {G. M.} and F. Rabboni and S. Conti and E. Fan and A. Pesenti and L. Brochard and A. Esteban and L. Gattinoni and {van Haren}, F. and A. Larsson and McAuley, {D. F.} and M. Ranieri and G. Rubenfeld and Thompson, {B. T.} and H. Wrigge and Slutsky, {A. S.} and F. Rios and T. Sottiaux and P. Depuydt and Lora, {F. S.} and Azevedo, {L. C.} and G. Bugedo and H. Qiu and M. Gonzalez and J. Silesky and V. Cerny and J. Nielsen and M. Jibaja and D. Matamis and Ranero, {J. L.} and P. Amin and Hashemian, {S. M.} and K. Clarkson and A. Villagomez and Zeggwagh, {A. A.} and Heunks, {L. M.} and Laake, {J. H.} and Palo, {J. E.} and {do Vale Fernandes}, A. and D. Sandesc and K. Shimizu",
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T1 - Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

AU - LUNG SAFE Investigators

AU - the ESICM Trials Group

AU - Abe, Toshikazu

AU - Madotto, Fabiana

AU - Pham, Tài

AU - Nagata, Isao

AU - Uchida, Masatoshi

AU - Tamiya, Nanako

AU - Kurahashi, Kiyoyasu

AU - Bellani, Giacomo

AU - Laffey, John G.

AU - Francois, G. M.

AU - Rabboni, F.

AU - Conti, S.

AU - Fan, E.

AU - Pesenti, A.

AU - Brochard, L.

AU - Esteban, A.

AU - Gattinoni, L.

AU - van Haren, F.

AU - Larsson, A.

AU - McAuley, D. F.

AU - Ranieri, M.

AU - Rubenfeld, G.

AU - Thompson, B. T.

AU - Wrigge, H.

AU - Slutsky, A. S.

AU - Rios, F.

AU - Sottiaux, T.

AU - Depuydt, P.

AU - Lora, F. S.

AU - Azevedo, L. C.

AU - Bugedo, G.

AU - Qiu, H.

AU - Gonzalez, M.

AU - Silesky, J.

AU - Cerny, V.

AU - Nielsen, J.

AU - Jibaja, M.

AU - Matamis, D.

AU - Ranero, J. L.

AU - Amin, P.

AU - Hashemian, S. M.

AU - Clarkson, K.

AU - Villagomez, A.

AU - Zeggwagh, A. A.

AU - Heunks, L. M.

AU - Laake, J. H.

AU - Palo, J. E.

AU - do Vale Fernandes, A.

AU - Sandesc, D.

AU - Shimizu, K.

PY - 2018/8/17

Y1 - 2018/8/17

N2 - 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.

AB - 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.

KW - Acute respiratory distress syndrome (ARDS)

KW - ICU

KW - Propensity-matched analysis

KW - Tracheostomy

KW - Ventilation

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