Published September 28, 2019
Early Tracheostomy In Severe Traumatic Brain Injury Is Associated With Decrease In Rate Of Ventilator-associated Pneumonia: An Analysis Of TQIP Data.
Patients with severe traumatic brain injury (sTBI) require intubation to ensure adequate oxygenation, and many progress to tracheostomy. However, tracheostomy timing is controversial. We have previously demonstrated that, in our institution, a lower incidence of ventilator-associated pneumonia in sTBI patients receiving early tracheostomy. Therefore, we sought to extend our results by evluating the American College of Surgeons Tauma Quality Improvement Program (TQIP) database to determine if an association between tracheostomy timing and development of ventilator-associated pnemonia exists.
The 2015 data from the TQIP was accessed and 5,662,524 patients were screened for inclusion in our retrospective analysis. Patients included in the analysis were those in whom tracheostomy was performed, had an isolated, sTBI, and those ultimately developing ventilator-associated pneumonia. Patients were matched by age and injury severity score. Fischer’s exact and multivariate analyses were used to observe the rate of pneumonia in TBI, the rate of tracheostomy in TBI, and impact of tracheostomy timing on the development of pneumonia. Hospital length of stay, number of days on a ventilator, and ICU length of stay were analyzed using a multivariate analysis.
A total of 4,045 patients met the inclusion criteria for our analysis. Five-hundred-sixty patients received tracheostomy by day 3 of their hospital stay (mean 1.15, SD 1.06) and 3,485 after day 3 (mean 10.44, SD 6.03). There were no statistically significant differences in age, ISS, respiratory rate, or oxygen saturation between the two groups. Early tracheostomy was associated with a rate of pneumonia of 10.23 (CI 7.86-13.02) compared to 21.49 (CI 20.15-22.88) in patients receiving trach after day 3 (OR 2.624, p-value 0.02).
Early tracheostomy was associated with a significant decrease in the rate of pneumonia in patients with severe traumatic brain injury. Future prospective studies are needed to validate the impact of early tracheostomy on patient morbidity and mortality in severe traumatic brain injury.
Chelsea Hoenes MD, Joshua K. Burk MD, Kabir Jalal PhD, Jeffery M. Jordan MD, PhD, University at Buffalo, SUNY.