Early versus late tracheostomy in patients with acute severe brain injury.
OBJECTIVE
To compare the effects of early tracheostomy and of late tracheostomy in patients with acute severe brain injury.


METHODS
A retrospective study involving 28 patients admitted to the ICU of the Federal University of Juiz de Fora University Hospital in Juiz de Fora, Brazil, diagnosed with acute severe brain injury and presenting with a Glasgow coma scale (GCS) score < 8 within the first 48 h of hospitalization. The patients were divided into two groups: early tracheostomy (ET), performed within the first 8 days after admission; and late tracheostomy (LT), performed after postadmission day 8. At admission, we collected demographic data and determined the following scores: Acute Physiology and Chronic Health Evaluation (APACHE) II, GCS and Sequential Organ Failure Assessment (SOFA).


RESULTS
There were no significant differences between the groups (ET vs. LT) regarding the demographic data or the scores: APACHE II (26 +/- 6 vs. 28 +/- 8; p = 0.37), SOFA (6.3 +/- 2.7 vs. 7.2 +/- 3.0; p = 0.43) and GCS (5.4 +/- 1.7 vs. 5.5 +/- 1.7; p = 0.87). The 28-day mortality rate was lower in the ET group (9% vs. 47%; p = 0.04). Nosocomial pneumonia occurring within the first 7 days was less common in the ET group, although the difference was not significant (0% vs. 23%; p = 0.13). There were no differences regarding the occurrence of late pneumonia or in the duration of mechanical ventilation between the groups.


CONCLUSIONS
On the basis of these findings, early tracheostomy should be considered in patients with acute severe brain injury.
Pinheiro
Bruno do Valle
Bdo V
Federal University of Juiz de Fora - Juiz de Fora, Brazil. bvalle@terra.com.br
Tostes
Rodrigo de Oliveira
Rde O
Brum
Carolina Ito
CI
Carvalho
Erich Vidal
EV
Pinto
Sérgio Paulo Santos
SP
Oliveira
Júlio César Abreu de
JC
D000208:Acute Disease; D001930:Brain Injuries / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control; D012121:Respiration, Artificial; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality