Tracheostomy After Severe Acute Brain Injury: Trends and Variability in the USA
Tracheostomy After Severe Acute Brain Injury: Trends and Variability in the USA
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DOI：
10.1007/s12028-019-00697-5
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发表时间：
2019-06-01
影响因子：
3.5
通讯作者：
Creutzfeldt, Claire J.
中科院分区：
文献类型：
--
作者：
Krishnamoorthy, Vijay;Hough, Catherine L.;Creutzfeldt, Claire J.
背景/目的严重急性脑损伤（SABI）每年导致1200万人死亡，幸存者长期残疾，并占用大量资源。关于SABI后气管切开术的适应症或最佳时机的指导很少。我们的目的是确定美国机械通气的SABI患者气管切开术使用的全国趋势，以及检查SABI后气管切开术使用的相关因素。方法采用2002 - 2011年全国住院患者样本，开展基于人群的回顾性队列研究。我们确定了SABI的成年患者，定义为主要诊断为中风、外伤性脑损伤或心脏骤停后，接受机械通气超过96小时。我们分析了气管切开术使用率随时间的变化趋势，并使用多水平混合效应logistic回归分析了与气管切开术使用率相关的因素。结果研究期间有94082例SABI住院，其中30455例（32%）采用气管切开术。在研究期间，SABI患者接受气管切开术的比例从2002年的28.0%增加到2011年的32.1%
Background/ObjectiveSevere acute brain injury (SABI) is responsible for 12 million deaths annually, prolonged disability in survivors, and substantial resource utilization. Little guidance exists regarding indication or optimal timing of tracheostomy after SABI. Our aims were to determine national trends in tracheostomy utilization among mechanically ventilated patients with SABI in the USA, as well as to examine factors associated with tracheostomy utilization following SABI.MethodsWe conducted a population-based retrospective cohort study using the National Inpatient Sample from 2002 to 2011. We identified adult patients with SABI, defined as a primary diagnosis of stroke, traumatic brain injury or post-cardiac arrest who received mechanical ventilation for greater than 96h. We analyzed trends in tracheostomy utilization over time and used multilevel mixed-effects logistic regression to analyze factors associated with tracheostomy utilization.ResultsThere were 94,082 hospitalizations for SABI during the study period, with 30,455 (32%) resulting in tracheostomy utilization. The proportion of patients with SABI who received a tracheostomy increased during the study period, from 28.0% in 2002 to 32.1% in 2011 (p