Does Early Tracheostomy Improve Outcome in Severe Head Injury?

Abstract

Object:  To determine if early tracheostomy reduces the duration of mechanical ventilation, Intensive Care Unit (ICU) stay and morbidities associated with it in patients with severe head injury.

Methods:  This 5-yr retrospective review included 60 ICU patients with severe traumatic head injury requiring mechanical ventilation and tracheostomy. Early tracheostomy (ET) was defined as tracheostomy within 7 days, and prolonged endotracheal intubation (EI) as endotracheal intubation for more than 7 days. Among 60 patients, 30 underwent early tracheostomy and 30 remained on prolong EI for ventilation. All patients were comparable in term of age and initial Glasgow Coma Scale (GCS). We evaluated groups regarding clinical outcome in terms of ventilator associated pneumonia (VAP), ICU stay and Glasgow Outcome Score (GOS).

Results:  The incidence of Ventilator Associated Pneumonia (VAP) was significantly higher in prolonged Endotracheal Intubation EI group, relative to Early tracheostomy ET group (63% vs. 43%, respectively). ET group showed significantly less ventilator days (9 days vs. 12 days), ICU stay (10 days vs. 13 days), complication rate (13% vs. 18%) and mortality (10% vs.25%). Clinical outcome assessed on the basis of Glascow Outcome Score (GOS) was better in ET group.

Conclusions:  In severe head injury early tracheostomy decreases total days of ventilation and ICU stay. Tracheostomy is associated with a decrease in the incidence of Ventilator Associated Pneumonia (VAP). Early tracheostomy should be considered in severe head injury patients requiring prolong ventilatory support.