Cost-effectiveness and Clinical Outcomes of Early Tracheostomy in the Patients of Isolated Head Injury: A Retrospective Study

Abstract

Introduction: Early tracheostomy (ET) proved to be effective in the intensive care unit (ICU) in patients who face difficulty in weaning off of mechanical ventilators easily. Tracheostomy is a common procedure applied in mechanically ventilated patients. It aims at reduction of complications and improvement of comfort of the patient. However, the benefits of the tracheostomy must be evaluated against the risks of the tracheostomy before its placement. Variables which are needed to be considered before performing a tracheostomy are the timing of the procedure, absence or presence of TBI, and severity of the injuries. Aim: To assess the cost-effectiveness and clinical outcomes of early tracheostomy in the patients of isolated head injury. Methodology: A total of 212 patients were included in the study. All the patients had isolated severe traumatic brain injury (TBI) and required mechanical ventilation. Tracheostomy was done within seven days of retaining TBI. Prolonged endotracheal intubation (EI) was defined as intubation more than seven days after TBI. A total of 103 (48.58%) patients underwent early tracheostomy (ET). A total of 109 (51.42%) patients underwent prolonged (EI). The patients were assessed according to the occurrence of ventilator associated pneumonia (VAP), Glasgow Outcome Score (GOS), and ICU stay. Results: The occurrence of VAP was 133 (62.74%) in the EI group which was higher compared to that of the ET group in which 79 (37.26%) had presented with VAP. The duration of need for a ventilator in the ET group was 10 days compared to 13 days of the prolonged EI group. Similarly, the need for ICU stay was 11 days in the ET group which was lesser than 13 days of the EI group. The complication rate in the ET group was 14% and in the EI group, it was 18%. The rate of mortality in the ET group was 7.77% and it was 16.51% in the EI group. The GCS of the ET group was better than the EI group. Moreover, the cost of the EI group was more than the ET group. Conclusion: ET reduces the total duration of ICU stay and ventilation in patients with severe TBI. The frequency of VAP is also lesser in the patients given ET. Hence, ET should be given in patients with severe head injuries that require prolonged support of mechanical ventilation