Secondary Brain Injury in Early and Late Tracheostomy in Severe Head Injury Patients

Authors

  • Fazal Ghani Department of Neurosurgery, Khyber Teaching Hospital, Peshawar – Pakistan
  • Muhammad Siddiq Department of Neurosurgery, Khyber Teaching Hospital, Peshawar – Pakistan
  • Muhammad Idrees Khan Department of Neurosurgery, Khyber Teaching Hospital, Peshawar – Pakistan

Keywords:

Tracheostomy, Head injury, Secondary brain injury, GCS.

Abstract

Objective: To determine the risk of secondary brain injury during tracheostomy in severe head injury patients.
Material and Methods: The study was carried on 180 patients of severe head injury admitted to Neuro ICU in Lady Reading hospital, Peshawar from March 2015 to March 2017. Early tracheostomy was performed in 95 and late tracheostomy in 85 patients. Patients on ventilator with spontaneous breathing and vitally stable were included and those with no spontaneous breathing, vitally unstable or had already tracheostomy been excluded.
Results: From a total of 180 patients, 95 (53%) and 85(47%) patients went under early and late tracheostomy group respectively. In the early group, 35 (37%) patients dropped GCS and 60 (63%) were static or improved. Further, patients who dropped GCS in early group, 32(91%) died while 3 (9%) improved or static. Even patients who improved in early group, 10 (17%) died while 50 (83%) improved or static. While in the late group, 9 (11%) dropped GCS more than 2 points and 76 (89%) were static or improved. Further, patients who dropped GCS in late group, 7 (78%) died while 2 (22%) improved or static. Even patients who improved in late group, 6(8%) died while 70 (92%) improved or static. Overall results of the study show that morbidity and mortality is high among early tracheostomy group than late group.
Conclusion: It is concluded that there is risk of secondary brain injury during tracheostomy.

References

1. Cheung NH, Napolitano LM. Tracheostomy: epidemio-logy, indications, timing, technique, and outcomes dis-cussion. Respiratory Care, 2014 June 1; 59 (6): 895-919.
2. Heffner JE, Hess D. Tracheostomy management in the chronically ventilated patient. Clin Chest Med. 2001; 22 (1): 55-69.
3. De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Y, et al. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg. 2007; 32 (3): 412-421. 23.
4. Rana S, Pendem S, Pogodzinski MS, Hubmayr RD, Gajic O. Tracheostomy in critically ill patients. Mayo Clin Proc. 2005; 80 (12): 1632-1638.
5. Freeman BD, Borecki IB, Coopersmith CM, Buchman TG. Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill pati-ents. Crit Care Med. 2005; 33 (11): 2513-2520.
6. Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical venti-lation. Chest, 1989; 96 (1): 178-1780.
7. Durbin CG Jr. Early complications of tracheostomy. Respiratory Care, 2005; 50 (4): 511-515.
8. Dunham CM, Cutrona AF, Gruber BS, Calderon JE, Ransom KJ, Flowers LL. Early tracheostomy in severe traumatic brain injury: evidence for decreased mecha-nical ventilation and increased hospital mortality. Inter-national Journal of Burns and Trauma. 2014; 4 (1): 14.
9. Arabi YM, Alhashemi JA, Tamim HM, Esteban A, Haddad SH, Dawood A, et al. The impact of time to tracheostomy on mechanical ventilation duration, len-gth of stay, and mortality in intensive care unit patients. J Crit Care, 2009; 24 (3): 435-440. 42.
10. Beltrame F, Zussino M, Martinez B, Dibartolomeo S,Saltarini M, Vetrugno L, et al. Percutaneous versus sur-gical bedside tracheostomy in the intensive care unit: a cohort study. Minerva Anestesiol. 2008; 74 (10): 529-535.
11. Gomes Silva BN, Andriolo RB, Saconato H, Atallah AN, Valente O. Early versus late tracheostomy for criti-cally ill patients. Cochrane Database Syst Rev. 2012; 3: CD007271.
12. Stocchetti N, Parma A, Songa V, Colombo A, Lamperti M, Tognini L. Early translaryngeal tracheostomy in patients with severe brain damage. Intensive Care Med. 2000; 26: 1101–1107.
13. Stocchetti N, Parma A, Lamperti M, Songa V, Tognini L. Neurophysiological consequences of three trachea-stomy techniques: a randomized study in neurosurgical patients. J Neurosurg Anesthesiol. 2000; 12: 307–313.
14. Kocaeli H, Korfali E, Taskapilioglu O, Ozcan T. Ana-lysis of intracranial pressure changes during early ver-sus late percutaneous tracheostomy in a neuro-intensive care unit. Acta Neurochir (Wien). 2008; 150: 1263–1267.
15. Reilly PM, Sing RF, Giberson FA, Anderson HL 3rd, Rotondo MF, Tinkoff GH, Schwab CW. Hypercarbia during tracheostomy: a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgi-cal tracheostomy. Intensive Care Med. 1997; 23: 859–864.
16. Greenberg MS. Handbook of neurosurgery.8th ed. Florida: Thieme Medical Publishers, Inc; 2016.
17. Dunham CM, Carter KJ, Castro F, Erickson B. Impact of cervical spine management brain injury on functional survival outcomes in comatose, blunt trauma patients with extremity movement and negative cervical spine CT: application of the Monte Carlo simulation. J Neu-rotrauma, 2011; 28: 1009–1019.

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Published

2018-06-30

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Original Articles