Early translaryngeal tracheostomy in patients with severe brain damage.
OBJECTIVE
To describe the effects of early translaryngeal tracheostomy on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and jugular bulb saturation (SjO2); to identify the main mechanisms affecting ICP during tracheostomy; and to evaluate the long-term effects of tracheostomy on tracheal anatomy and function.


METHODS
Prospective, observational, clinical study.


METHODS
Neurosurgical intensive care unit in a teaching hospital.


METHODS
20 patients admitted to the ICU because of head injury, subarachnoid hemorrhage, or brain tumor with a Glasgow Coma Scale less than 8.


METHODS
Patients underwent translaryngeal tracheostomy under strict neuromonitoring.


RESULTS
ICP rose significantly (p < 0.05) at the critical time of cannula placement while all other parameters remained stable. At this time five patients suffered intracranial hypertension (ICP > 20 mmHg). In one of them CPP dropped below 60 mmHg. Arterial CO2 tension (PaCO2) did not rise significantly. No other major complications were recorded during the procedures. Three months after tracheostomy normal findings were detected by tracheoscopy in all cases (11 patients could be examined).


CONCLUSIONS
Translaryngeal tracheostomy, performed in selected patients when the risk of intracranial hypertension was reduced to the minimum, was well tolerated in the majority of cases and did not induce persistent intracranial disorders. However, ICP is affected by tracheostomy, and careful monitoring and patient selection is necessary. At follow-up no severe anatomical or functional damage was detected.
Stocchetti
N
N
Department Anesthesia and Intensive Care, Neuroscience Intensive Care, Policlinico Hospital IRCCS, Milan, Italy. stocchet@polic.cilea.it
Parma
A
A
Songa
V
V
Colombo
A
A
Lamperti
M
M
Tognini
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001930:Brain Injuries / Q000150:complications / Q000628:therapy*; D001932:Brain Neoplasms / Q000150:complications / Q000628:therapy*; D003128:Coma / Q000209:etiology; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods*