The impact of early tracheostomy in neurotrauma patients: A Retrospective study

Abstract

Background:Although majority of neurotrauma patients require long term ventilatory support but the timing of tracheostomy in such patients is controversial.Method:This retrospective study was conducted at a Tertiary Care Hospital, Pune, India. Patients >18 years of age, who underwent percutaneous tracheostomy (PCT) from June 2010 to November 2014 at neurotrauma unit (NTU) of hospital, were included. Patients were divided in two groups according to the timing of tracheostomy, early tracheostomy (ET) group (≤5 days; N=100) and late tracheostomy (LT) group (>5 days; N=64). The nonparametric Mann-Whitney test, and Chi-square tests were used to compare these groups.Result:There were no significant differences between the groups in terms of age, sex, APACHE II and GCS Score. Patients in the ET group had a significantly shorter stay in the NTU compared to patients in the LT group (mean, 18 vs. 21.2 days, p=0.005), fewer mechanical ventilation days (mean, 8.1 vs. 11.7 days, P=0.000) and shorter length of stay in hospital (mean, 28.8 vs. 34.37 days, P=0.019). There was no difference between ET and LT groups in post PCT ventilator free days (mean, 8.2 vs. 9.4 days; P=0.094). Mortality rates in ET vs. LT groups were also comparable (35% vs. 29.7%; P=0.480).Conclusion:Results suggest that ET in neurotrauma patients might be associated with shorter length of stay in NTU and hospital, and shorter duration of mechanical ventilation however there was no mortality difference.

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

“…23 Two other studies also showed comparable results to the previous study-that patients with ET had a shorter ICU stay compared with LT patients, 20,22 fewer days of MV, shorter duration of hospital stay, and lower incidence of nosocomial pneumonia, 20,22 though mortality rates in ET versus LT were comparable. 22 Alali et al in a cohort of 1,811 patients also observed lower probabilities of pneumonia, deep vein thrombosis, and decubitus ulcers; hospital mortality was similar between groups; unlike the majority, they also evaluated other additional variables with increased possible benefits of ET. 21 Two other large multicenter studies deserve to be mentioned.…”

“…Literature supports that these can go from one to several days, and the benefits regarding the incidence of pneumonia and mortality were variable, which makes evident the great heterogeneity in the different studies. 21,22 Khalili et al defined ET as less than 6 days after admission and concluded that patients with ET had a significantly shorter hospital as well as ICU stay, although mortality rates were not significantly different between the two groups; also, the Glasgow Outcome Scale (GOS) more than 4 was higher and ventilator-associated pneumonia was lower among the ET group. They also showed that ET significantly improved prognosis at 6 months (GOS >4).…”

“…Tube dislodgement occurs within the first week and is a medical emergency because it could be difficult to replace creating a false tract; it occurs when the patient is moved, or the tube is replaced, or even when the patients by itself get extubated. 22,54,[57][58][59][60] The late complications appear with a prolonged tube placement and are divided by the anatomic location related to the stoma (suprastomal, stomal, and infrastomal). 55,57 When the patients undergo cricothyroidotomy, the suprastomal complications are the most frequent injuries and the patients present with tracheal or subglottic stenosis.…”

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations

“…The various retrospective studies 25,28,42,43,51,52 conducted in different patient subsets also confirmed that the timing of tracheostomy does not reduce in hospital mortality.…”

“…In the retrospective study by Zirpe et al 28 conducted in neurointensive care unit, it was found that early tracheostomy results in shorter stay in ICU (mean, 28.8 vs. 34.37 days, P = 0.019).…”