Tracheostomy timing and outcome in critically ill patients with stroke: a meta-analysis and meta-regression

Critical Care

卷:27

Research

Nicole White¹  Brian H. Cuthbertson²  Sung-Min Cho³  Jose I. Suarez³  Christopher Camarda⁴  Lavienraj Premraj⁵  Denise Battaglini⁶  Paolo Pelosi⁷  Chiara Robba⁷  Patricia R. M. Rocco⁸  Daniel Agustin Godoy⁹ 

[1] Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia;

[2] Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;University Department of Anaesthesiology in Pain Medicine, University of Toronto, Toronto, ON, Canada;

[3] Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anaesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA;

[4] Griffith University School of Medicine, Gold Coast, Queensland, Australia;

[5] Griffith University School of Medicine, Gold Coast, Queensland, Australia;Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia;

[6] IRCCS Ospedale Policlinico San Martino, Genova, Italy;

[7] IRCCS Ospedale Policlinico San Martino, Genova, Italy;Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy;

[8] Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;

[9] Neurointensive Care Unit, Critical Care Department, Sanatorio Pasteur, Chacabuco 675, 4700, Catamarca, Argentina;

关键词: Stroke;    Tracheostomy;    Mechanical ventilation;    Ischaemic;    Haemorrhagic;    Critically ill;   

DOI  :  10.1186/s13054-023-04417-6

 received in 2023-02-21, accepted in 2023-03-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundStroke patients requiring mechanical ventilation often have a poor prognosis. The optimal timing of tracheostomy and its impact on mortality in stroke patients remains uncertain. We performed a systematic review and meta-analysis of tracheostomy timing and its association with reported all-cause overall mortality. Secondary outcomes were the effect of tracheostomy timing on neurological outcome (modified Rankin Scale, mRS), hospital length of stay (LOS), and intensive care unit (ICU) LOS.MethodsWe searched 5 databases for entries related to acute stroke and tracheostomy from inception to 25 November 2022. We adhered to PRISMA guidance for reporting systematic reviews and meta-analyses. Selected studies included (1) ICU-admitted patients who had stroke (either acute ischaemic stroke, AIS or intracerebral haemorrhage, ICH) and received a tracheostomy (with known timing) during their stay and (2) > 20 tracheotomised. Studies primarily reporting sub-arachnoid haemorrhage (SAH) were excluded. Where this was not possible, adjusted meta-analysis and meta-regression with study-level moderators were performed. Tracheostomy timing was analysed continuously and categorically, where early (< 5 days from initiation of mechanical ventilation to tracheostomy) and late (> 10 days) timing was defined per the protocol of SETPOINT2, the largest and most recent randomised controlled trial on tracheostomy timing in stroke patients.ResultsThirteen studies involving 17,346 patients (mean age = 59.8 years, female 44%) met the inclusion criteria. ICH, AIS, and SAH comprised 83%, 12%, and 5% of known strokes, respectively. The mean time to tracheostomy was 9.7 days. Overall reported all-cause mortality (adjusted for follow-up) was 15.7%. One in five patients had good neurological outcome (mRS 0–3; median follow-up duration was 180 days). Overall, patients were ventilated for approximately 12 days and had an ICU LOS of 16 days and a hospital LOS of 28 days. A meta-regression analysis using tracheostomy time as a continuous variable showed no statistically significant association between tracheostomy timing and mortality (β = − 0.3, 95% CI = − 2.3 to 1.74, p = 0.8). Early tracheostomy conferred no mortality benefit when compared to late tracheostomy (7.8% vs. 16.4%, p = 0.7). Tracheostomy timing was not associated with secondary outcomes (good neurological outcome, ICU LOS and hospital LOS).ConclusionsIn this meta-analysis of over 17,000 critically ill stroke patients, the timing of tracheostomy was not associated with mortality, neurological outcomes, or ICU/hospital LOS.Trial registration: PROSPERO—CRD42022351732 registered on 17th of August 2022.

【 授权许可】

CC BY   
© The Author(s) 2023

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