Muristek
Early vs Standard Approach to Tracheostomy and Functional Outcome After Severe Stroke
To the Editor In the subgroup analysis of the recently published Stroke-Related Early Tracheostomy vs Prolonged Orotracheal Intubation in Neurocritical Care Trial 2 (SETPOINT2), the enrolled patients were divided into 3 subgroups according to their pathology diagnosis: acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. However, the type of stroke is not necessarily related to the need for tracheostomy. We believe it would be helpful to classify these patients based on the location of brain infarction, including distinct categories for brainstem or cerebellar stroke. The purpose of tracheostomy in patients with severe stroke is not only to provide mechanical ventilation but also to protect the airway. Airway protection is particularly important in patients with stroke who have impaired swallow and cough reflexes. Because these reflexes are primarily controlled by the brainstem, patients with stroke affecting this area of the brain are more likely to have impaired cough and swallow reflexes. Prior studies have shown that patients with brainstem diseases and space-occupying cerebellar diseases are more likely to undergo tracheostomy.
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