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Impact of Early Tracheostomy on Clinical Outcomes in Trauma Patients Admitted the to Intensive Care Unit: A Retrospective Causal Analysis

  • Author Footnotes
    3 Chi Peng, Fan Yang, Liwei Peng, and Hang Yu contributed equally to this work and are co-first authors.
    Chi Peng
    Footnotes
    3 Chi Peng, Fan Yang, Liwei Peng, and Hang Yu contributed equally to this work and are co-first authors.
    Affiliations
    Department of Health Statistics, Naval Medical University, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    3 Chi Peng, Fan Yang, Liwei Peng, and Hang Yu contributed equally to this work and are co-first authors.
    Liwei Peng
    Footnotes
    3 Chi Peng, Fan Yang, Liwei Peng, and Hang Yu contributed equally to this work and are co-first authors.
    Affiliations
    Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
    Search for articles by this author
  • Author Footnotes
    3 Chi Peng, Fan Yang, Liwei Peng, and Hang Yu contributed equally to this work and are co-first authors.
    Fan Yang
    Footnotes
    3 Chi Peng, Fan Yang, Liwei Peng, and Hang Yu contributed equally to this work and are co-first authors.
    Affiliations
    Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University) and Key Laboratory of Tumor Immunopathology, Ministry of Education of China, Chongqing, China
    Search for articles by this author
  • Author Footnotes
    3 Chi Peng, Fan Yang, Liwei Peng, and Hang Yu contributed equally to this work and are co-first authors.
    Hang Yu
    Footnotes
    3 Chi Peng, Fan Yang, Liwei Peng, and Hang Yu contributed equally to this work and are co-first authors.
    Affiliations
    Emergency Department, Changhai Hospital, Naval Medical University, Shanghai, China
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  • Peng Wang
    Affiliations
    Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
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  • Chao Cheng
    Affiliations
    Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
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  • Wei Zuo
    Affiliations
    Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
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  • Weixin Li
    Correspondence
    Address correspondence to Weixin Li, MD, Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No.1 Xinsi Road, Xi'an, China, 710038.
    Affiliations
    Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
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  • Zhichao Jin
    Correspondence
    Zhichao Jin, PhD, Department of Health Statistics, Naval Medical University, No. 800 Xiangyin Road, Shanghai, China, 200433.
    Affiliations
    Department of Health Statistics, Naval Medical University, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    3 Chi Peng, Fan Yang, Liwei Peng, and Hang Yu contributed equally to this work and are co-first authors.
Published:December 25, 2022DOI:https://doi.org/10.1053/j.jvca.2022.12.022

      Objectives

      To assess the indications, timing, and clinical outcomes that result from the early tracheostomy (ET) administration, by causal inference models.

      Design

      A retrospective observational study.

      Setting

      Multiinstitutional intensive care unit in the United States

      Participants

      The study comprised 626 trauma patients.

      Interventions

      An ET versus late tracheostomy (LT).

      Measurements and Main Results

      Trauma patients with tracheostomy were identified from 2 public databases named Medical Information Mart for the Intensive Care-IV and eICU Collaborative Research Database. Tracheostomy was defined as early (≤7 days) or late (>7 days) from intensive care unit admission. A marginal structural Cox model (MSCM) with inverse probability weighting was employed. For comparison, the authors also used time-dependent propensity-score matching (PSM) to account for differences in the probability of receiving an ET or LT. A total of 626 eligible patients were enrolled in the study, of whom 321 (51%) received a ET. The MSCM and time-dependent PSM indicated that the ET group was associated with reduced ventilation-associated pneumonia (VAP) and a shorter mechanical ventilation (MV) duration than the LT group. Yet, mortality did not show any difference between the two groups.

      Conclusions

      The authors’ study observed that ET was not associated with reduced mortality in trauma patients, but it was associated with reduced VAP risk and MV duration. The results warrant further validation in randomized controlled trials.

      Key Words

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