Early versus delayed tracheostomy in patients with severe cranioencephalic trauma

Abstract

Introduction: Severe traumatic brain injury (TBI) is a condition that creates high levels of disability and mortality in Latin America. The optimal moment to perform tracheostomy in these patients remains controversial. The aim of this study was to compare the morbidity and mortality with early versus late tracheostomy in patients with severe head injury in the ICU in a university Hospital in Colombia. Materials and Methods: 159 patients with severe head injury treated at Neiva University Hospital between February 2009 to 2014 were included in this study. The patients were divided into two groups: early tracheostomy (first 8 days after admission) and late tracheostomy (8 days after admission). Statistical analysis of clinical-demographic variables was evaluated, and a statistical analysis of pneumonia and mortality associated with mechanical ventilation comparing the two groups with Chi-square test was performed. Results: Of the 159 patients with severe head injury admitted to the ICU during this period, 64 (40.2%) underwent tracheostomy. Of those, 36 received an early tracheostomy, while 28 underwent late tracheostomy. Pneumonia associated with mechanical ventilation was present in 15 of the 36 (42%) patients, 65% of whom were in the late tracheotomy group. Overall survival for early tracheostomy group was 69.4% and 57.1% for the late group tracheostomy. Conclusions: Early tracheostomy should be considered in patients with severe head trauma to prevent further hospital morbidity and especially ventilator-associated pneumonia.