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Outcomes After Tracheostomy in Patients With Severe Acute Brain Injury: A Systematic Review and Meta-Analysis

45 Pages Posted: 8 Oct 2018

See all articles by Sarah Wahlster

Sarah Wahlster

University of Washington - Department of Neurology

Monisha Sharma

University of Washington, School of Public Health, Department of Global Health

Frances Chu

University of Washington - Health Science Library

Justin Granstein

University of Washington - Department of Neurology

W. T. Longstreth

University of Washington - Department of Neurology

Claire J. Creutzfeldt

University of Washington - Department of Neurology

More...

Abstract

Background: Tracheostomy rates in mechanically ventilated neurological patients are high, though long-term outcomes are incompletely understood. We aimed to analyze long-term outcomes of patients with severe acute brain injury (SABI) after tracheostomy.

Methods: We searched Pubmed, EMBASE and the Cochrane Library between 1990 and 2017 for studies of adult patients with SABI who underwent tracheostomy placement. We excluded select patient populations and studies reporting selective outcomes as well as other neurological populations. We assessed study quality using a customized Newcastle-Ottawa Scale. Data was abstracted with a standardized collection template; authors of individual studies were contacted for additional data. We used a random effects model (single proportions with 95% CIs) to pool results. The primary outcome was functional outcome at 6 months or longer. Secondary outcomes included short-term and long-term mortality, decannulation rates, and discharge home rates.

Findings: Of 1,137 studies identified, 45 underwent full manuscript review and 17 studies from 9 countries were included in the meta-analysis. Long-term outcome was available from four studies comprising 354 patients with stroke, where 26% (95% CI 11-50) achieved independence. The pooled short-term mortality for 18,860 patients with stroke (6 studies) and TBI (10 studies) was 14%, (95% CI 11-17) and the pooled long-term mortality was 23% (95% CI 11-42). At long-term follow-up, 79% (95% CI 51-93) of stroke survivors had been decannulated. Only 4% (SD 0.4) of stroke patients were discharged directly from the hospital to home. Heterogeneity was high for most outcome assessments (I2>75%).

Interpretation: If we accept the substantial heterogeneity across studies, our findings suggest that one in 4 patients with SABI who undergo tracheostomy can eventually achieve independence. Future research is needed to better understand the reasons for this heterogeneity and identify those patients with promising outcomes as well as factors influencing outcome.

Funding Statement:The authors declare: "none."

Declaration of Interests: The authors state: "We declare no competing interests." Dr. Claire J. Creutzfeldt receives funding from the NIH–National Institutes of Neurological Disease and Stroke (NINDS) (K23 NS099421).

Ethics Approval Statement: The authors developed a prespecified protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) checklist.

Suggested Citation

Wahlster, Sarah and Sharma, Monisha and Chu, Frances and Granstein, Justin and Longstreth, W. T. and Creutzfeldt, Claire J., Outcomes After Tracheostomy in Patients With Severe Acute Brain Injury: A Systematic Review and Meta-Analysis (February 10, 2018). Available at SSRN: https://ssrn.com/abstract=3260798 or http://dx.doi.org/10.2139/ssrn.3260798

Sarah Wahlster (Contact Author)

University of Washington - Department of Neurology ( email )

WA
United States

Monisha Sharma

University of Washington, School of Public Health, Department of Global Health ( email )

WA
United States

Frances Chu

University of Washington - Health Science Library ( email )

WA
United States

Justin Granstein

University of Washington - Department of Neurology

WA
United States

W. T. Longstreth

University of Washington - Department of Neurology ( email )

WA
United States

Claire J. Creutzfeldt

University of Washington - Department of Neurology

WA
United States