Earlier tracheostomy and percutaneous endoscopic gastrostomy in patients with hemorrhagic stroke: associated factors and effects on hospitalization

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OBJECTIVE

Existing literature supports benefits of early tracheostomy and percutaneous endoscopic gastrostomy (PEG) in certain patient populations. The aim of this study was to review tracheostomy and PEG placement data in patients with hemorrhagic stroke in order to identify factors associated with earlier placement and to evaluate outcomes.

METHODS

The authors performed a retrospective review of consecutive patients treated for hemorrhagic stroke between June 1, 2011, and June 1, 2015. Data were analyzed by logistic and multiple linear regression.

RESULTS

Of 240 patients diagnosed with hemorrhagic stroke, 31.25% underwent tracheostomy and 35.83% underwent PEG tube placement. Factors significantly associated with tracheostomy and PEG included the presence of pneumonia on admission and subarachnoid hemorrhage. Earlier tracheostomy was significantly associated with shorter ICU length of stay; earlier tracheostomy and PEG placement were associated with shorter overall hospitalization. Timing of tracheostomy and PEG was not significantly associated with patient survival or the incidence of complications in this population.

CONCLUSIONS

This study identified patient risk factors associated with increased likelihood of tracheostomy and PEG in patients with hemorrhagic stroke who were critically ill. Additionally, we found that the timing of tracheostomy was associated with length of ICU stay and overall hospital stay, and that the timing of PEG was associated with overall length of hospitalization. Complication rates related to tracheostomy and PEG in this population were minimal. This retrospective data set supports some benefit to earlier tracheostomy and PEG placement in this population and justifies the need for further prospective study.

ABBREVIATIONS DVT = deep venous thrombosis; ICH = intracerebral hemorrhage; PEG = percutaneous endoscopic gastrostomy; SAH = subarachnoid hemorrhage; SETPOINT = Stroke-Related Early Tracheostomy versus Prolonged Orotracheal Intubation in Neurocritical Care Trial; UTI = urinary tract infection; VAP = ventilator-associated pneumonia; VPS = ventriculoperitoneal shunting.
Article Information

Contributor Notes

Correspondence Justin F. Fraser: University of Kentucky, Lexington, KY. jfr235@uky.edu.INCLUDE WHEN CITING Published online January 4, 2019; DOI: 10.3171/2018.7.JNS181345.Disclosures Dr. Fraser has direct stock ownership in Fawkes Biotechnology, and he is a consultant for Stream Biomedical and Medtronic.
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