J Korean Neurotraumatol Soc.  2009 Dec;5(2):89-92. 10.13004/jknts.2009.5.2.89.

Early and Late Tracheostomy after Decompressive Craniectomy for Severe Traumatic Brain Injury

• Kim TH
• Kim HS
• Yang SH
• Kim IS
• Hong JT
• Sung JH
• Son BC
• Lee SW

• KMID: 1427364
• DOI: http://doi.org/10.13004/jknts.2009.5.2.89

Abstract

OBJECTIVE
The purpose of the study was to retrospectively compare the early and late tracheostomy in terms of ventilator days, intensive care unit (ICU) days, pneumonia, and clinical outcomes in patients with a severe traumatic brain injury (TBI) who underwent a decompressive craniectomy.
METHODS
Patients who had a TBI and a Glasgow Coma Scale (GCS) score < or =8, and were treated with a unilateral or bilateral decompressive craniectomy were enrolled. Between January 2006 and December 2008, 37 patients were enrolled in the retrospective study. Percutaneous tracheostomies were performed by trained residents. According to the timing of the tracheostomy, the subjects were classified as the early (< or =7 days; n=20) or late group (>7 days; n=17).
RESULTS
The average time of the tracheostomy was 3.2+/-1.4 days in the early group and 9.7+/-0.9 days in the late group. There was no statistically significant difference between the early and late groups with respect to total days of mechanical ventilation, ICU stay, Glasgow Outcome Score (GOS), and pneumonia incidence. The duration of antibiotic administration for the treatment of pneumonia was shorter in the early group (p=0.04). Klebsiella species were the most common pathogens in both groups.
CONCLUSION
Early tracheostomy decreased the antibiotic period for the treatment of pneumonia in patients with severe TBI who underwent decompressive craniectomy. Early tracheostomy did not reduce total time of mechanical ventilation, ICU stay, pneumonia incidence, and GOS.

Keyword

Tracheostomy; Traumatic brain injury; Pneumonia; Intensive care unit

MeSH Terms

Brain Injuries
Decompressive Craniectomy
Glasgow Coma Scale
Humans
Incidence
Intensive Care Units
Klebsiella
Pneumonia
Respiration, Artificial
Retrospective Studies
Tracheostomy
Ventilators, Mechanical

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