Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries.
BACKGROUND
To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study.


METHODS
This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort.


RESULTS
Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample.


CONCLUSIONS
Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality.


TRIAL REGISTRATION
ClinicalTrials.gov, NCT02010073 . Registered on 12 December 2013.
['Abe|Toshikazu|T|', 'Madotto|Fabiana|F|', 'Pham|Tài|T|', 'Nagata|Isao|I|', 'Uchida|Masatoshi|M|', 'Tamiya|Nanako|N|', 'Kurahashi|Kiyoyasu|K|', 'Bellani|Giacomo|G|', 'Laffey|John G|JG|', '|||']
D000368:Aged D015331:Cohort Studies D016638:Critical Illness D005260:Female D006801:Humans D007362:Intensive Care Units D038622:Internationality D008297:Male D008875:Middle Aged D057216:Propensity Score D011446:Prospective Studies D012121:Respiration, Artificial D012128:Respiratory Distress Syndrome D012720:Severity of Illness Index D014139:Tracheostomy
Tracheostomy ICU Acute respiratory distress syndrome (ARDS) Ventilation Propensity-matched analysis