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Supplementary materials and methods:
TS-related complications included pneumothorax, emphysema, hematoma, fracture of trachea support rings and failed intervention.
Respiratory adverse occurrences included acute respiratory distress syndrome, atelectasis, need of reintubation, pneumothorax (not TS-related). Pneumonia was diagnosed using modified criteria from the guidelines of the Paul-Ehrlich-Society, (1) specifically the evidence of infiltration in chest x-ray plus two of the following three criteria: fever (>38,3
°C), leukocytosis (> 10 000/ml) or positive microbiological culture.
Cardiovascular adverse events were considered to be cardiopulmonary arrest, myocardial infarction, acute arterial occlusion (including pulmonary embolism), deep venous thrombosis and major arrhythmia.
Adverse neurological events included progression of neurological insult or hemorrhage, seizures and elevated cranial pressure requiring medical or surgical treatment.
Sepsis, septicemia and different focuses of infection (central line, urinary tract, gastrointestinal tract, central nervous system) were considered as infectious adverse events.
The definition criteria of sepsis or septicemia we defined in accordance with the guidelines of the surviving sepsis campaign. (2) In order to be regarded as a focus of infection at least one positive microbiological sample and clinical signs of infection, e.g. fever, elevated CRP and leukocytosis had to be present.
Procedures
Unless there were no contraindications against percutaneous dilatational TS we used the Ciaglia Blue Rhino technique as standard procedure. Based on Seldinger's technique it is nowadays the most common method for percutaneous TS (3) and was mainly performed bedside in our ICU; if surgical TS was indicated, the procedure was done in the OR. Surgical TS was indicated in patients whom physical conditions didn't permit the percutaneous method, i.e. previous anterior cervical surgery or complex anatomical situations with the difficulty to set an alternative translaryngeal airway in case of complications. Two intensivists were always present to manage ventilation and anesthesia during the procedure.
Supplementary Figures Supplementary Figure I
Supplementary Figure 1. Distribution of patients undergoing tracheostomy. Early tracheostomy was defined as day 1-7 after admission to ICU, late tracheostomy as day 8-20 after admission to the ICU. In total, 39 patients underwent early tracheostomy and 109 patients underwent late tracheostomy.
Supplementary Tables
Supplementary Table 1. Details of tracheostomies performed. Data are given as means.
Values given in parenthesis indicate standard deviation unless declared otherwise. Data comparisons were made with Mann Whitney U-test or 2-test, where applicable. There were no significant differences between both groups in all parameters analyzed.
Supplementary Table 2. Univariable and multivariable analysis of parameters associated with poor neurological outcome. Data comparisons were made with 2-test for univariable analysis and binary logistic regression with stepwise exclusion for multivariable analysis.
GCS = Glasgow coma scale; WFNS = World Federation of Neurosurgical Societies; OR indicates odds ratio. CI indicates confidence interval.
Supplementary Table 3. Univariable and multivariable analysis of parameters associated with respiratory AE. Data comparisons were made with 2-test for univariable analysis and binary logistic regression with stepwise exclusion was used for multivariable analysis. GCS = Glasgow coma scale; WFNS = World Federation of Neurosurgical Societies; OR indicates odds ratio. CI indicates confidence interval.
Supplementary Table 4. Univariable and multivariable analysis of parameters associated with overall survival. Data comparisons were made with Kaplan-Meier estimates for univariable analysis. Column median indicates calculated median of parameter displayed. No median was calculated for “No obliteration performed” as all cases were censored. n/r = median was not reached by group in survival analysis. Cox-regression analysis with stepwise exclusion was used for multivariable analysis. GCS = Glasgow coma scale; WFNS = World Federation of Neurosurgical Societies; HR indicates hazard ratio. CI indicates confidence interval.
Supplementary Table 5. Poor-grade SAH atients not undergoing TS on day 1-20. Data are given as means. Data comparisons were made with Mann Whitney U-test or 2-test, where applicable. WFNS = World Federation of Neurosurgical Societies; mRS = modified Rankin index; ICU = intensive care unit
Supplementary references:
1. Dalhoff K, Abele-Horn M, Andreas S, et al. [Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia. S-3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy]. Pneumologie 2012;66(12):707-765.
2. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39(2):165-228.
3. Baumann HJ, Kemei C, Kluge S. [Tracheostomy in the intensive care unit]. Pneumologie 2010;64(12):769-776.
