{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T23:55:05Z","timestamp":1780358105488,"version":"3.54.1"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.7.jns181345","type":"journal-article","created":{"date-parts":[[2019,2,27]],"date-time":"2019-02-27T00:15:39Z","timestamp":1551226539000},"page":"87-93","source":"Crossref","is-referenced-by-count":22,"title":["Earlier tracheostomy and percutaneous endoscopic gastrostomy in patients with hemorrhagic stroke: associated factors and effects on hospitalization"],"prefix":"10.3171","volume":"132","author":[{"given":"Matthew R.","family":"McCann","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery;"},{"name":"College of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin W.","family":"Hatton","sequence":"additional","affiliation":[{"name":"College of Medicine;"},{"name":"Department of Anesthesiology;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga A.","family":"Vsevolozhskaya","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, College of Public Health;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin F.","family":"Fraser","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery;"},{"name":"College of Medicine;"},{"name":"Department of Neurology;"},{"name":"Department of Radiology; and"},{"name":"Department of Neuroscience, University of Kentucky, Lexington, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1097\/TA.0b013e3182a8fd6a","article-title":"Tracheostomy timing in traumatic brain injury: a propensity-matched cohort study","volume":"76","author":"Alali AS","year":"2014","unstructured":"Alali AS, Scales DC, Fowler RA, Mainprize TG, Ray JG, Kiss A, : Tracheostomy timing in traumatic brain injury: a propensity-matched cohort study. J Trauma Acute Care Surg 76:70\u201378, 20142436835910.1097\/TA.0b013e3182a8fd6a"},{"key":"b2","series-title":"Crit Care","doi-asserted-by":"publisher","first-page":"R347","DOI":"10.1186\/cc2924","article-title":"Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review","volume":"8","author":"Arabi Y","year":"2004","unstructured":"Arabi Y, Haddad S, Shirawi N, Al Shimemeri A: Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Crit Care 8:R347\u2013R352, 20041546957910.1186\/cc2924"},{"key":"b3","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1161\/STROKEAHA.112.669895","article-title":"Stroke-Related Early Tracheostomy versus Prolonged Orotracheal Intubation in Neurocritical Care Trial (SETPOINT): a randomized pilot trial","volume":"44","author":"B\u00f6sel J","year":"2013","unstructured":"B\u00f6sel J, Schiller P, Hook Y, Andes M, Neumann JO, Poli S, : Stroke-Related Early Tracheostomy versus Prolonged Orotracheal Intubation in Neurocritical Care Trial (SETPOINT): a randomized pilot trial. Stroke 44:21\u201328, 201310.1161\/STROKEAHA.112.66989523204058"},{"key":"b4","series-title":"Laryngoscope","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1288\/00005537-199205000-00015","article-title":"The role of early tracheotomy in the management of the neurosurgical patient","volume":"102","author":"Boyd SW","year":"1992","unstructured":"Boyd SW, Benzel EC: The role of early tracheotomy in the management of the neurosurgical patient. Laryngoscope 102:559\u2013562, 199210.1288\/00005537-199205000-000151573953"},{"key":"b5","series-title":"Rev Bras Otorrinolaringol (Engl Ed)","first-page":"428","article-title":"[Impact of early elective tracheotomy in critically ill patients.]","volume":"80","author":"Correia IA","year":"2014","unstructured":"Correia IA, Sousa V, Pinto LM, Barros E: [Impact of early elective tracheotomy in critically ill patients.] Rev Bras Otorrinolaringol (Engl Ed) 80:428\u2013434, 2014 (Portuguese)"},{"key":"b6","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1016\/S0140-6736(05)17983-5","article-title":"Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial","volume":"365","author":"Dennis MS","year":"2005","unstructured":"Dennis MS, Lewis SC, Warlow C: Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet 365:764\u2013772, 20051573371710.1016\/S0140-6736(05)17983-5"},{"key":"b7","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1161\/STROKEAHA.114.006891","article-title":"Novel score predicting gastrostomy tube placement in intracerebral hemorrhage","volume":"46","author":"Faigle R","year":"2015","unstructured":"Faigle R, Marsh EB, Llinas RH, Urrutia VC, Gottesman RF: Novel score predicting gastrostomy tube placement in intracerebral hemorrhage. Stroke 46:31\u201336, 20152546888110.1161\/STROKEAHA.114.006891"},{"key":"b8","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1161\/STROKEAHA.116.015119","article-title":"Timing of percutaneous endoscopic gastrostomy for acute ischemic stroke: an observational study from the US Nationwide Inpatient Sample","volume":"48","author":"George BP","year":"2017","unstructured":"George BP, Kelly AG, Albert GP, Hwang DY, Holloway RG: Timing of percutaneous endoscopic gastrostomy for acute ischemic stroke: an observational study from the US Nationwide Inpatient Sample. Stroke 48:420\u2013427, 201710.1161\/STROKEAHA.116.01511927965430"},{"key":"b9","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"2429","DOI":"10.1097\/CCM.0000000000001195","article-title":"The impact of tracheostomy timing on clinical outcome and adverse events in poor-grade subarachnoid hemorrhage","volume":"43","author":"Gessler F","year":"2015","unstructured":"Gessler F, Mutlak H, Lamb S, Hartwich M, Adelmann M, Platz J, : The impact of tracheostomy timing on clinical outcome and adverse events in poor-grade subarachnoid hemorrhage. Crit Care Med 43:2429\u20132438, 201510.1097\/CCM.000000000000119526308429"},{"key":"b10","series-title":"Cochrane Database Syst Rev","first-page":"CD008096","article-title":"Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances","volume":"5","author":"Gomes CA Jr","year":"2015","unstructured":"Gomes CA Jr, Andriolo RB, Bennett C, Lustosa SA, Matos D, Waisberg DR, : Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev (5):CD008096, 2015"},{"key":"b11","series-title":"Nutr Neurosci","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1179\/1476830513Y.0000000078","article-title":"Comparison of nutritional status indicators according to feeding methods in patients with acute stroke","volume":"17","author":"Kim S","year":"2014","unstructured":"Kim S, Byeon Y: Comparison of nutritional status indicators according to feeding methods in patients with acute stroke. Nutr Neurosci 17:138\u2013144, 20142386346310.1179\/1476830513Y.0000000078"},{"key":"b12","series-title":"Eur Respir J","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1183\/09031936.05.00096104","article-title":"Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients","volume":"26","author":"Kostadima E","year":"2005","unstructured":"Kostadima E, Kaditis AG, Alexopoulos EI, Zakynthinos E, Sfyras D: Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients. Eur Respir J 26:106\u2013111, 200510.1183\/09031936.05.00096104"},{"key":"b13","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.nec.2009.10.014","article-title":"Outcome and cost of aneurysmal subarachnoid hemorrhage","volume":"21","author":"le Roux AA","year":"2010","unstructured":"le Roux AA, Wallace MC: Outcome and cost of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am 21:235\u2013246, 201010.1016\/j.nec.2009.10.01420380966"},{"key":"b14","series-title":"Consensus en endoscope digestive (CED) gastrostomie et j\u00e9junostomie percutan\u00e9es endoscopiques","author":"Le Sidaner A","year":"2007","unstructured":"Le Sidaner A, Bouteloup C, Cano N, Schneider S, Lachaux A, Michaud L, : Consensus en endoscope digestive (CED) gastrostomie et j\u00e9junostomie percutan\u00e9es endoscopiques. Paris: Soci\u00e9t\u00e9 Fran\u00e7aise d\u2019Endoscopie Digestive, 2007 (http:\/\/www.sfed.org\/files\/documents_sfed\/files\/recommandations\/GastrostomieJejunostomie.pdf) [Accessed August 29, 2018]"},{"key":"b15","series-title":"Clin Nutr","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1016\/j.clnu.2005.08.010","article-title":"Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients","volume":"24","author":"Martineau J","year":"2005","unstructured":"Martineau J, Bauer JD, Isenring E, Cohen S: Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients. Clin Nutr 24:1073\u20131077, 20051621306410.1016\/j.clnu.2005.08.010"},{"key":"b16","series-title":"J Intensive Care Med","article-title":"Outcomes of tracheostomy with concomitant and delayed percutaneous endoscopic gastrostomy in the neuroscience critical care unit","author":"Nobleza COS","unstructured":"Nobleza COS, Pandian V, Jasti R, Wu DH, Mirski MA, Geocadin RG: Outcomes of tracheostomy with concomitant and delayed percutaneous endoscopic gastrostomy in the neuroscience critical care unit. J Intensive Care Med [epub ahead of print], 201728675111"},{"key":"b17","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"899","DOI":"10.3171\/2016.8.JNS152701","article-title":"Systematic review of ventricular peritoneal shunt and percutaneous endoscopic gastrostomy: a safe combination","volume":"127","author":"Oterdoom LH","year":"2017","unstructured":"Oterdoom LH, Marinus Oterdoom DL, Ket JCF, van Dijk JMC, Scholten P: Systematic review of ventricular peritoneal shunt and percutaneous endoscopic gastrostomy: a safe combination. J Neurosurg 127:899\u2013904, 20172791123110.3171\/2016.8.JNS152701"},{"key":"b18","series-title":"J Bras Pneumol","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1590\/S1806-37132010000100014","article-title":"Early versus late tracheostomy in patients with acute severe brain injury","volume":"36","author":"Pinheiro BdoV","year":"2010","unstructured":"Pinheiro BdoV, Tostes RdeO, Brum CI, Carvalho EV, Pinto SP, Oliveira JC: Early versus late tracheostomy in patients with acute severe brain injury. J Bras Pneumol 36:84\u201391, 20102020931210.1590\/S1806-37132010000100014"},{"key":"b19","series-title":"Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1159\/000080771","article-title":"Outcome of survivors of acute stroke who require prolonged ventilatory assistance and tracheostomy","volume":"18","author":"Rabinstein AA","year":"2004","unstructured":"Rabinstein AA, Wijdicks EF: Outcome of survivors of acute stroke who require prolonged ventilatory assistance and tracheostomy. Cerebrovasc Dis 18:325\u2013331, 200410.1159\/00008077115359100"},{"key":"b20","series-title":"Surg Clin North Am","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1016\/j.suc.2012.08.007","article-title":"Patient safety in the critical care environment","volume":"92","author":"Rossi PJ","year":"2012","unstructured":"Rossi PJ, Edmiston CE Jr: Patient safety in the critical care environment. Surg Clin North Am 92:1369\u20131386, 201210.1016\/j.suc.2012.08.00723153874"},{"key":"b21","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1097\/01.CCM.0000134835.05161.B6","article-title":"Hazard PB: A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients","volume":"32","author":"Rumbak MJ","year":"2004","unstructured":"Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB: A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 32:1689\u20131694, 20041528654510.1097\/01.CCM.0000134835.05161.B6"},{"key":"b22","series-title":"Neurocrit Care","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1007\/s12028-015-0235-5","article-title":"The SETscore to predict tracheostomy need in cerebrovascular neurocritical care patients","volume":"25","author":"Sch\u00f6nenberger S","year":"2016","unstructured":"Sch\u00f6nenberger S, Al-Suwaidan F, Kieser M, Uhlmann L, B\u00f6sel J: The SETscore to predict tracheostomy need in cerebrovascular neurocritical care patients. Neurocrit Care 25:94\u2013104, 201610.1007\/s12028-015-0235-526842719"},{"key":"b23","series-title":"Int J Stroke","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1177\/1747493015616638","article-title":"Early tracheostomy in ventilated stroke patients: Study protocol of the international multicentre randomized trial SETPOINT2 (Stroke-Related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical Care Trial 2)","volume":"11","author":"Sch\u00f6nenberger S","year":"2016","unstructured":"Sch\u00f6nenberger S, Niesen WD, Fuhrer H, Bauza C, Klose C, Kieser M, : Early tracheostomy in ventilated stroke patients: Study protocol of the international multicentre randomized trial SETPOINT2 (Stroke-Related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical Care Trial 2). Int J Stroke 11:368\u2013379, 201610.1177\/174749301561663826763913"},{"key":"b24","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1016\/S0003-9993(00)90097-2","article-title":"Perceptual differences between stroke patients with cerebral infarction and intracerebral hemorrhage","volume":"81","author":"Su CY","year":"2000","unstructured":"Su CY, Chang JJ, Chen HM, Su CJ, Chien TH, Huang MH: Perceptual differences between stroke patients with cerebral infarction and intracerebral hemorrhage. Arch Phys Med Rehabil 81:706\u2013714, 200010.1016\/S0003-9993(00)90097-210857510"},{"key":"b25","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/S1474-4422(09)70340-0","article-title":"Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis","volume":"9","author":"van Asch CJ","year":"2010","unstructured":"van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ: Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 9:167\u2013176, 20102005648910.1016\/S1474-4422(09)70340-0"},{"key":"b26","series-title":"Richtlijn Percutane Endoscopische Gastrostomie sonde (PEG-sonde) plaatsing bij pati\u00ebnten met Amyotrofische Laterale Sclerose (ALS)","author":"van den Berg JP","year":"2010","unstructured":"van den Berg JP, de Goeijen JC, Kruitwagen-van Reenen ET, Piepers S, van der Kooi AJ, Westermann EJA: Richtlijn Percutane Endoscopische Gastrostomie sonde (PEG-sonde) plaatsing bij pati\u00ebnten met Amyotrofische Laterale Sclerose (ALS). Amsterdam: ALS Centrum Nederland, 2010 (http:\/\/www.als-centrum.nl\/wp-content\/uploads\/2013\/11\/Richtlijn-PEG-bij-ALS1.pdf) [Accessed August 30, 2018]"},{"key":"b27","series-title":"Respir Care","first-page":"1408","article-title":"Time to wean after tracheotomy differs among subgroups of critically ill patients: retrospective analysis in a mixed medical\/surgical intensive care unit","volume":"51","author":"van der Lely AJ","year":"2006","unstructured":"van der Lely AJ, Veelo DP, Dongelmans DA, Korevaar JC, Vroom MB, Schultz MJ: Time to wean after tracheotomy differs among subgroups of critically ill patients: retrospective analysis in a mixed medical\/surgical intensive care unit. Respir Care 51:1408\u20131415, 2006"},{"key":"b28","series-title":"J Stroke Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.09.008","article-title":"Tracheostomy timing affects stroke recovery","volume":"23","author":"Villwock JA","year":"2014","unstructured":"Villwock JA, Villwock MR, Deshaies EM: Tracheostomy timing affects stroke recovery. J Stroke Cerebrovasc Dis 23:1069\u20131072, 20142455591910.1016\/j.jstrokecerebrovasdis.2013.09.008"},{"key":"b29","series-title":"J Stroke Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"2694","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.07.017","article-title":"Practice patterns of percutaneous endoscopic gastrostomy tube placement in acute stroke: are the guidelines achievable?","volume":"25","author":"Wilmskoetter J","year":"2016","unstructured":"Wilmskoetter J, Simpson AN, Simpson KN, Bonilha HS: Practice patterns of percutaneous endoscopic gastrostomy tube placement in acute stroke: are the guidelines achievable? J Stroke Cerebrovasc Dis 25:2694\u20132700, 20162747552110.1016\/j.jstrokecerebrovasdis.2016.07.017"},{"key":"b30","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1016\/j.clineuro.2012.08.010","article-title":"Predictors of tracheostomy in patients with spontaneous intracerebral hemorrhage","volume":"115","author":"Yaghi S","year":"2013","unstructured":"Yaghi S, Moore P, Ray B, Keyrouz SG: Predictors of tracheostomy in patients with spontaneous intracerebral hemorrhage. Clin Neurol Neurosurg 115:695\u2013698, 201310.1016\/j.clineuro.2012.08.01022910395"},{"key":"b31","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"2121","DOI":"10.1001\/jama.2013.5154","article-title":"Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial","volume":"309","author":"Young D","year":"2013","unstructured":"Young D, Harrison DA, Cuthbertson BH, Rowan K: Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA 309:2121\u20132129, 201310.1001\/jama.2013.515423695482"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/132\/1\/article-p87.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/132\/1\/article-p87.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/132\/1\/article-p87.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T09:04:27Z","timestamp":1658739867000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/132\/1\/article-p87.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":31,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2018.7.jns181345","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]}}}