The effects of early tracheostomy on outcomes of patients with severe head injury

TLDR: Early trachostomy is associated with shorter lengths of stay in ICU and hospital, and need to ventilation support and lower nosocomial pneumonia than in late tracheostomy among patients with severe head injury.

Abstract: BAckground: This study was designed to compare the length of ICU and hospital stay, need to ventilation support, and nosocomial pneumonia, in sever head injury patients, between early and late tracheostomy. Methods: A randomized clinical trial was done. In a period of 2 years, tracheostomy (20 early and 20 late) was did in 40 patients with sever head injury(GCS ≤ 8), without lung disease or severe chest injuries, which was hospitalized in Al-Zahra or Ayatollah Kashani hospitals of Isfahan city. Tracheostomy was defined as early if performed in 4th day of reception. The length of ICU and hospital stay, need to ventilation support, and occurrence of pneumonia was registered. P value < 0.05 considered to indicate statistical significance. Findings: The mean duration of ICU stay in early and late tracheostomy groups was respectively 20.58 and 28.15 days (P = 0.015), and for hospital stay was respectively 30.25 and 36.55 days (P = 0.042). The mean duration need to ventilation support was respectively 8.90 and 12.25 days (P = 0.049). The pneumonia was occurred in early and late tracheostomy in 8 and 19 cases, respectively (P < 0.001). The sex, age, and patient’s GCS in time of reception to ICU or release of it was not associated with kind of tracheostomy. Conclusion: Early tracheostomy is associated with shorter lengths of stay in ICU and hospital, and need to ventilation support and lower nosocomial pneumonia than in late tracheostomy among patients with severe head injury. Key words:Early tracheostomy, Late tracheostomy, Sever head injury, Nosocomial pneumonia, ICU.