The role of early tracheostomy in severe head injuries
Abstract
Introduction: Tracheostomy is a simple but life saving procedure which has been practiced in the National Neurosurgical Referral Centre (NNRC) in patients who require either prolonged ventilation or tracheo-bronchial toileting. In this study early tracheostomy were categorized as the ones that were performed within seven days of the injury and late were the ones performed after seven days. The objective is to determine the value of early tracheostomy in severe head injury patients who required either prolonged ventilation or tracheobronchial toileting. This is a retrospective study of all Neurosurgical patients including traumatic brain injury with GCS of less than 8 who underwent tracheostomy since January 2005 to January 2010 at NNRC. Outcome was measured on the basis of Glasgow Outcome Score at three months. Altogether 259 patients had tracheostomy among which tumour and cerebrovascular disease accounted for 38 cases. The remaining 221 cases of severe head injuries constitute the subject for present study. Of the study population 168 were male and 53 females, the age ranged from 6 to 70 years and all patients had GCS of less than 8 on admission. Altogether 180 had early tracheostomy and 41 had it done late for indications already specified. Among the early tracheostomy group 122 (68%) had favourable outcome as compared to 13 (32%) in the late group. This showed significant favourable outcome in early tracheostomy group. Procedure related complications included local infection in 33 (15%), haemorrhage in 4 (1.8%), tube dislodgement and obstruction in 4 (1.8%) and subcutaneous emphysema in 3 (1.4%).Conclusion: This study shows statistically significant favourable outcome in early tracheostomy in comatosed head injured patients if they require tracheostomy for prolonged ventilation or bronchial toileting.References
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Jha R ... The role of early tracheostomy
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2. Arabi Y, Hddad S, Shirawi N, Al Shimemeri A. Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Crit Care. 2004;8:R347–R352. doi: 10.1186/cc2924.
3. Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B,
Jha R ... The role of early tracheostomy
Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma Inj Infect and Crit Care. 2004;57:251– 254.
4. Sugerman HJ, Wolfe L, Pasquale MD, Rogers FB, O’Malley KF, Knudson M, DiNardo L, Gordon M, Schaffer S. Multicenter, randomized, prospective trial of early tracheostomy. J Trauma. 1997;43:741–747.
5. Lesnik I, Rappaport W, Fulginiti J, Witzke D. The role of early tracheostomy in blunt, multiple organ trauma. Am Surg. 1992;58:346–349.
6. Gurkin MA, Parikshak M, Kralovich KA. Indicators for tracheostomy in patients with traumatic brain injury. Am Surg. 2002;68:324–328.
7. Santos PM, Afrassiabi A, Weymuller EA. Risk factors associated with prolonged intubation and laryngeal injury. Otolaryngol Head Neck Surg. 1994;111:453–459.
8. Armstrong PA, McCarthy MC, Peoples JB. Reduced use of resources by early tracheostomy in ventilatordependent patients with blunt trauma. Surgery. 1998;124:763–766. doi: 10.1067/msy.1998.91224.
9. Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM. Early tracheostomy for primary airway management in the surgical critical care setting. Surgery. 1990;108:655–659.
10. Kluger Y, Paul DB, Lucke J, Cox P, Colella JJ, Townsend RN, Raves JJ, Diamond DL. Early tracheostomy in trauma patients. Eur J Emerg Med. 1996;3:95–101.
11. Teoh WH, Goh KY, Chan CL. The role of early tracheostomy in critically ill neurosurgical patients. Ann Acad Med Singapore. 2001;30:234–238.
12. D’Amelio, Lf.;Hammond, JS.;Spain, DA.; Sutyak, JP. Tracheostomy and percutaneous endoscopic gastrostomy in the management of the head injured trauma patient. Am Surg. 1994;60:180–185.
13. Stauffer JL, Olson DE, Petty TL. Complication and consequences of endotracheal intubation and tracheostomy: a prospective study of 150 critically ill patients. Am J Med. 1981;70:65–76. doi: 10.1016/00029343(81)90413-7.
14. Lanza DC, Parnes SM, Koltai PJ, Fortune JB. Early complications of airway management in head-injured patients. Larygoscope. 1990;100:958–961.
15. Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989;96:178–180.
Published
2015-03-20
How to Cite
JHA, R.
The role of early tracheostomy in severe head injuries.
J Soc Surg Nep, [S.l.], v. 14, n. 1, mar. 2015.
ISSN 2392-4772.
Available at: <https://www.jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=25>. Date accessed: 05 oct. 2024.
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