Title:Timing of Tracheostomy in Patients with Intracerebral Haemorrhage:
A Propensity-Matched Analysis
Volume: 19
Issue: 3
Author(s): Bo Luo, Hua-Xuan Chen, Xu-Dong Song, Lin Wang, Long Zhao and Xiao-Ping Tang*
Affiliation:
- Department of Neurosurgery, The Affiliated Hospital of North Sichuan Medical College, No. 1,
Maoyuan South Road, 637000, Nanchong, Sichuan Province, China
Keywords:
Intracerebral haemorrhage, tracheostomy, propensity matching analysis, endotracheal intubation, respiratory failure, sedatives.
Abstract:
Aims: Although early tracheostomy (ET) is recommended for patients with severe stroke,
the optimal timing of tracheostomy for patients with intracerebral haemorrhage (ICH) remains controversial.
This study aimed to explore the clinical characteristics, risk factors and timing of tracheostomy
in patients after tracheal intubation using a propensity-matched analysis.
Methods: We conducted a retrospective database search and assessed 267 consecutive patients who
underwent endotracheal intubation (175 of whom underwent tracheostomy) and ICH between July
2017 and June 2021. A logistic regression model was applied to identify the critical factors influencing
the decision for tracheostomy by comparing factors in a tracheostomy group and a nontracheostomy
group. Patients were divided into an early (≤5 days) or a late (>5 days) group according
to the median time of tracheostomy. Propensity score matching was performed to adjust for
possible confounders and investigate differences in outcomes between ET and late tracheostomy
(LT).
Results: Among the 267 enrolled patients with ICH and endotracheal intubation, 65.5% received
tracheostomy during hospitalisation, and 52.6% received ET. The independent risk factors for tracheostomy
included National Institute of Health Stroke Scale (NIHSS) (odds ratio [OR]: 1.179; 95%
confidence interval [CI]: 1.028-1.351; P = 0.018), aspiration (OR: 2.171; 95% CI: 1.054-4.471; P =
0.035) and infiltrates (OR: 2.149; 95% CI: 1.088-4.242; P = 0.028). Using propensity matching, we
found that ET was associated with fewer antibiotic-using days (15 vs. 18; P < 0.001) and sedativeusing
days (6 vs. 8; P < 0.001), shorter intensive care unit (ICU) Length of Study (LOS) (9 vs. 12; P
< 0.05) and reduced in-ICU costs (3.59 vs. 7.4; P < 0.001) and total hospital costs (8.26 vs. 11.28,
respectively; P < 0.001). Muscle relaxants (31.8% vs. 60.6%) were used less frequently in patients
with ET (P = 0.001). However, there were no differences between the ET and LT groups in terms of
modified Rankin Scale (mRS) (4 vs. 4; P = 0.932), in-general-ward costs (4.74 vs. 4.37; P = 0.052),
mechanical ventilation days (6 vs. 6; P = 0.961) and hospital LOS (23 vs. 23; P = 0.735) as well as
the incidences of ventilator-associated pneumonia (28.8% vs. 37.9%; P = 0.268), tracheostomyrelated
complications (16.7% vs. 19.7%; P = 0.652), respiratory failure (24.2% vs. 31.8%; P =
0.333), all-cause deaths (15.2% vs. 16.7%; P = 0.812) and pneumonia (77.3% vs. 87.9%; P = 0.108).
Conclusion: We recommend ET for high-risk patients with ICH. Although ET cannot reduce inhospital
mortality or improve patient prognosis, it may help reduce hospital costs and ICU LOS as
well as the use of antibiotics, sedatives and muscle relaxants.
