title: Early versus late tracheostomy in patients with acute severe brain injury.
abstract: 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.
authors.affiliation: Federal University of Juiz de Fora - Juiz de Fora, Brazil. bvalle@terra.com.br
authors.forename: Bruno do Valle
authors.initials: Bdo V
authors.lastname: Pinheiro
authors.forename: Rodrigo de Oliveira
authors.initials: Rde O
authors.lastname: Tostes
authors.forename: Carolina Ito
authors.initials: CI
authors.lastname: Brum
authors.forename: Erich Vidal
authors.initials: EV
authors.lastname: Carvalho
authors.forename: Sérgio Paulo Santos
authors.initials: SP
authors.lastname: Pinto
authors.forename: Júlio César Abreu de
authors.initials: JC
authors.lastname: Oliveira
mesh_terms: 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