title: Clinical outcome and cost effectiveness of early tracheostomy in isolated severe head injury patients.
abstract: BACKGROUND
  Early tracheostomy (ET) has been shown to be effective in reducing complications associated with prolong mechanical ventilation. The study was carried out to evaluate the role of ET in reducing the duration of mechanical ventilation, duration of intensive care unit (ICU) stay, ICU-related morbidities, and its overall effect on outcome, in patients with isolated severe traumatic brain injury (TBI).
  
  
  METHODS
  This 7-year review included 100 ICU patients with isolated severe TBI requiring mechanical ventilation. ET was defined as tracheostomy within 7 days of TBI, and prolonged endotracheal intubation (EI) as EI exceeding 7 days of TBI. Of 100 patients, 49 underwent ET and 51 remained on prolong EI for ventilation. All patients were comparable in term of age and initial Glasgow Coma Scale (GCS). We evaluated groups regarding clinical outcome in terms of ventilator-associated pneumonia (VAP), ICU stay, and Glasgow Outcome Score (GOS).
  
  
  RESULTS
  The frequency of VAP was higher in EI group relative to ET group (63% vs. 45%, P value 0.09). ET group showed significantly less ventilator days (10 days vs. 13 days, P value 0.031), ICU stay (11 days vs. 13 days, P value 0.030), complication rate (14% vs. 18%), and mortality (8.2% vs. 17.6%). Clinical outcome assessed on the basis of GOS was also better in the ET group. Total inpatient cost was also considerably less (USD $8027) in the ET group compared with the EI group (USD $9961).
  
  
  CONCLUSIONS
  In patients with severe TBI, ET decreases total days of ventilation and ICU stay, and is associated with a decrease in the frequency of VAP. ET should be considered in severe head injury patients requiring prolong ventilatory support.
authors.affiliation: Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Usman Tariq
authors.initials: UT
authors.lastname: Siddiqui
authors.affiliation: Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Muhammad Zubair
authors.initials: MZ
authors.lastname: Tahir
authors.affiliation: Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Muhammad Shahzad
authors.initials: MS
authors.lastname: Shamim
authors.affiliation: Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Syed Ather
authors.initials: SA
authors.lastname: Enam
keywords: Early tracheostomy; prolonged endotracheal intubation; severe traumatic brain injury