title: Impact of percutaneous dilatational tracheostomy in brain injured patients.
abstract: OBJECTIVE
  Tracheostomy is an established method in the airway management of critically ill patients with traumatic and non-traumatic brain injuries. High priority in the treatment of those patients is to protect vulnerable brain tissue. While bedside percutaneously dilatative tracheostomy (PDT) technique is increasingly used, there is disagreement about the harms of this intervention for the damaged brain. Therefore, discussions about the safety of tracheostomy in those patients must consider direct and indirect cerebral parameters.
  
  
  METHODS
  We examined a series of 289 tracheostomies regarding vital signs, respiratory and intracranial parameters in a retrospective study. Complications were recorded and risk factors for a complicated scenario statistically determined.
  
  
  RESULTS
  Severe complications were rare (1/289). Arterial hypotension occurred in 3 of 289 cases with a systolic blood pressure below 90mmHg. We had two patients (0.5%) with transient hypoxia, but 43 cases (15%) of severe hypercapnia during PDT. Invasive measurement of brain tissue oxygen tension (PBrO2) ruled out any cerebral hypoxia during the procedure in 39 available cases. Intracranial pressure (ICP) rose temporarily in 24% of the cases. Cerebral perfusion pressure (CPP) however remained unaffected. Surgery time and hypercapnia are capable risk factors for intraoperative ICP elevation. There is no significant difference in intraoperative ICP rises between disease entities.
  
  
  CONCLUSIONS
  PDT is a safe procedure for the most common neurosurgical diseases, even for patients with respiratory insufficiency. Shortening surgical time seems to be the most important factor to avoid ICP increase.
authors.affiliation: Department of Neurosurgery, University of Luebeck, Germany.
authors.forename: Jan Nils
authors.initials: JN
authors.lastname: Kuechler
authors.affiliation: Department of Neurosurgery, University of Luebeck, Germany.
authors.forename: Abdulkareem
authors.initials: A
authors.lastname: Abusamha
authors.affiliation: Department of Neurosurgery, University of Luebeck, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Ziemann
authors.affiliation: Department of Neurosurgery, University of Luebeck, Germany.
authors.forename: Volker Martin
authors.initials: VM
authors.lastname: Tronnier
authors.affiliation: Department of Neurosurgery, University of Luebeck, Germany. Electronic address: jan.gliemroth@t-online.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Gliemroth
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001930:Brain Injuries / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology*; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology*; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods
keywords: Brain tissue oxygen tension; Cerebral perfusion pressure; Intracranial pressure; Percutaneously dilatative tracheostomy