title: The effect of tracheostomy performed within 72 h after traumatic brain injury.
abstract: The optimal timing of tracheostomy in patients with traumatic brain injury (TBI) remains unclear. The purpose of this study was to examine the effects of tracheostomy performed within 72 h after admission. In this retrospective cohort study, the authors reviewed the data for a series of 120 consecutive patients who underwent tracheostomy after suffering TBI with an Abbreviated Injury Scale (AIS) score of ≥4. The exclusion criteria were as follows: age <18 years, severe chest injury with an AIS score of ≥4, and a requirement for intubation because of upper airway obstruction. Patients who underwent tracheostomy ≤72 h and >72 h after admission were classified into early group and control groups, respectively. The duration of mechanical ventilation, length of stay (LOS) in intensive care unit (ICU), incidence of pneumonia, adverse event rate, unnecessary tracheostomy and outcomes were compared between the two groups. Of the 120 patients, 29 were excluded from the study, 40 were classified into the early group, and 51 were classified into the control group. The duration of mechanical ventilation and LOS in ICU were significantly less in the early group than in the control group. The 30-day mortality rates were 3% and 8% for the early and control groups, respectively. There was no significant difference in the adverse event rate, incidence of pneumonia, unnecessary tracheostomy rate and the rate of favorable outcome between groups. The results of this study suggest that the performance of tracheostomy within 72 h of admission may decrease the duration of mechanical ventilation and LOS in ICU, with acceptable mortality and morbidity rates.
authors.affiliation: a Department of Emergency and Intensive Care Center , Tokyo Metropolitan Bokutoh Hospital , Sumida-ku , Tokyo , Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Shibahashi
authors.affiliation: a Department of Emergency and Intensive Care Center , Tokyo Metropolitan Bokutoh Hospital , Sumida-ku , Tokyo , Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sugiyama
authors.affiliation: a Department of Emergency and Intensive Care Center , Tokyo Metropolitan Bokutoh Hospital , Sumida-ku , Tokyo , Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Houda
authors.affiliation: a Department of Emergency and Intensive Care Center , Tokyo Metropolitan Bokutoh Hospital , Sumida-ku , Tokyo , Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takasu
authors.affiliation: a Department of Emergency and Intensive Care Center , Tokyo Metropolitan Bokutoh Hospital , Sumida-ku , Tokyo , Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hamabe
authors.affiliation: b Department of Neurological Surgery , Nippon Medical School , Bunkyou-ku , Tokyo , Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Morita
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000601:surgery*; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Head trauma; head injury; neurosurgical intensive care; severer head injury; tracheostomy; traumatic brain injury