US Practitioner Attitudes Toward Tracheostomy Timing, Benefits, Risks, and Techniques for Severe Stroke Patients: A Nati
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US Practitioner Attitudes Toward Tracheostomy Timing, Benefits, Risks, and Techniques for Severe Stroke Patients: A National Survey and National Inpatient Sample Analysis Charlie W. Zhao1, David Y. Hwang2*and the SETPOINT2 Survey Investigators © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
The stroke-related early tracheostomy versus prolonged orotracheal intubation in neurocritical care trial 2 (SETPOINT2) is a recently completed multicenter study started in 2016 to investigate the optimal timing of tracheostomy in patients intubated with severe stroke [1]. When SETPOINT2 was undergoing planning via the neurocritical care research network (NCRN), a survey was conducted to assess attitudes of US Neurocritical Care Society (NCS) members toward tracheostomy timing, techniques, and benefits and risks for severe stroke patients. As a precursor to the upcoming release of the SETPOINT2 results, we report the results of this original planning survey to share its insights into beliefs among neuro-ICU practitioners related to stroke and tracheostomy timing, methodology, and decision making. For external validation of the survey’s results regarding when tracheostomy is typically performed, we report an analysis of the mean number of days to tracheostomy among those patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage in the National Inpatient Sample (NIS) who received tracheostomy during their hospitalization. In 2014, the planners of the SETPOINT2 trial developed an online 7-item English-language survey with multiple-choice questions related to a practitioner’s belief *Correspondence: [email protected] 2 Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, P.O. Box 208018, New Haven, CT 06520, USA Full list of author information is available at the end of the article
regarding standard of care for tracheostomy and the severe stroke patient. Question domains included timing of tracheostomy, perceived benefits and harms, and details regarding how tracheostomies are performed at a clinician’s institution. Three questions, “What benefits of tracheostomy do you believe may help your stroke patients?”, “What potential harms of tracheostomy concern you most?”, and “Who performs most of the tracheostomies at your NICU?”, included additional free-response sections. None of the questions asked a participant for identifying information. The survey was reviewed for content and face validity by the leadership of the NCRN and the NCS Research Committee. An Institutional Review Board exemption to administer the survey to US NCS members was obtained from Maine Medical Center. The survey was advertised to US NCS members via e-mail (SurveyMonkey, San Mateo, CA, USA) over a onemonth period in July 2014. Participation was voluntary and no financial incentive was given. We analyzed results via standard descriptive statistics in Microsoft Excel 2016 (Redmond, WA, USA). Three reviewers
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