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Tracheostomy practi...
Tracheostomy practice and timing in traumatic brain-injured patients : a CENTER-TBI study
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Robba, Chiara (författare)
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Galimberti, Stefania (författare)
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Graziano, Francesca (författare)
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visa fler...
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Wiegers, Eveline J. A. (författare)
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Lingsma, Hester F. (författare)
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Iaquaniello, Carolina (författare)
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Stocchetti, Nino (författare)
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Menon, David (författare)
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Citerio, Giuseppe (författare)
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- Koskinen, Lars-Owe D., Professor, 1955- (bidragsgivare)
- Umeå universitet,Institutionen för klinisk vetenskap,The CENTER-TBI ICU
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- Brorsson, Camilla (bidragsgivare)
- Umeå universitet,Anestesiologi och intensivvård
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visa färre...
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(creator_code:org_t)
- 2020-02-05
- 2020
- Engelska.
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Ingår i: Intensive Care Medicine. - : Springer Berlin/Heidelberg. - 0342-4642 .- 1432-1238. ; 46, s. 983-994
- Relaterad länk:
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https://link.springe...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- PURPOSE: Indications and optimal timing for tracheostomy in traumatic brain-injured (TBI) patients are uncertain. This study aims to describe the patients' characteristics, timing, and factors related to the decision to perform a tracheostomy and differences in strategies among different countries and assess the effect of the timing of tracheostomy on patients' outcomes.METHODS: We selected TBI patients from CENTER-TBI, a prospective observational longitudinal cohort study, with an intensive care unit stay ≥ 72 h. Tracheostomy was defined as early (≤ 7 days from admission) or late (> 7 days). We used a Cox regression model to identify critical factors that affected the timing of tracheostomy. The outcome was assessed at 6 months using the extended Glasgow Outcome Score.RESULTS: Of the 1358 included patients, 433 (31.8%) had a tracheostomy. Age (hazard rate, HR = 1.04, 95% CI = 1.01-1.07, p = 0.003), Glasgow coma scale ≤ 8 (HR = 1.70, 95% CI = 1.22-2.36 at 7; p < 0.001), thoracic trauma (HR = 1.24, 95% CI = 1.01-1.52, p = 0.020), hypoxemia (HR = 1.37, 95% CI = 1.05-1.79, p = 0.048), unreactive pupil (HR = 1.76, 95% CI = 1.27-2.45 at 7; p < 0.001) were predictors for tracheostomy. Considerable heterogeneity among countries was found in tracheostomy frequency (7.9-50.2%) and timing (early 0-17.6%). Patients with a late tracheostomy were more likely to have a worse neurological outcome, i.e., mortality and poor neurological sequels (OR = 1.69, 95% CI = 1.07-2.67, p = 0.018), and longer length of stay (LOS) (38.5 vs. 49.4 days, p = 0.003).CONCLUSIONS: Tracheostomy after TBI is routinely performed in severe neurological damaged patients. Early tracheostomy is associated with a better neurological outcome and reduced LOS, but the causality of this relationship remains unproven.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Nyckelord
- Mechanical ventilation
- Outcome
- Tracheostomy
- Traumatic Brain Injury
- neurokirurgi
- Neurosurgery
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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- Av författaren/redakt...
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Robba, Chiara
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Galimberti, Stef ...
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Graziano, France ...
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Wiegers, Eveline ...
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Lingsma, Hester ...
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Iaquaniello, Car ...
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visa fler...
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Stocchetti, Nino
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Menon, David
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Citerio, Giusepp ...
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Koskinen, Lars-O ...
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Brorsson, Camill ...
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visa färre...
- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Neurologi
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Anestesi och int ...
- Artiklar i publikationen
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Intensive Care M ...
- Av lärosätet
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Umeå universitet
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Karolinska Institutet