Skip to main content

Does early tracheostomy affect the duration of mechanical ventilation in patients with severe traumatic head injuries?

Abstract

Background and purpose

Tracheostomy is a surgical procedure performed frequently in intensive care units (ICUs). Prolonged mechanical ventilation (MV) is the main indication for tracheostomy in ICUs. This study was conducted to investigate if early tracheostomy affects the duration of mechanical ventilation in patients with severe traumatic head injuries.

Patients and Methods

It is a prospective, randomized study in which patients with severe post-traumatic head injuries, with a Glasgow Coma Scale of less than 8, were included. Patients were randomized into two groups; group of early tracheostomy (ET) included 53 patients subjected to tracheostomy before the seventh day of intubation and group of late tracheostomy (LT) included 34 patients subjected to tracheostomy on or after the seventh day of intubation. The total duration of mechanical ventilation, the complications of tracheostomy, and mortality were recorded.

Results

The mean duration of mechanical ventilation of ET group (ET=10.97±6.82) was statistically significantly shorter than the LT group (LT=16.28±8.65) (P=0.002). Complications were minor and not life threating. No mortalities were detected because of tracheostomy.

Conclusion

Tracheostomy is a safe procedure with acceptable rate of minor complications. Early tracheostomy, before the seventh day of intubation, significantly shortens the duration of mechanical ventilation in patients with severe traumatic head injuries.

References

  1. 1

    Blomstedt P. Tracheostomy in ancient Egypt. J Laryngol Otol 2014; 128: 665–668.

    Article  Google Scholar 

  2. 2

    Paul J, Pracy M, Rogers M. Tracheostomy. In: Watkinson JC, Gilbert RW, editors. Stell & Maran’s textbook of head and neck surgery and oncology. 5th ed. New York: Taylor & Francis; 2012.

    Google Scholar 

  3. 3

    Durbin CG Jr. Indications for and timing of tracheostomy. Respir Care 2005; 50:483–487.

    PubMed  Google Scholar 

  4. 4

    Ahmed N, Kuo YH. Early versus late tracheostomy in patients with severe traumatic head injury. Surg Infect (Larchmt) 2007; 8: 343–347.

    Article  Google Scholar 

  5. 5

    Rizk EB, Patel AS, Stetter CM, Chinchilli VM, Cockroft KM. Impact of tracheostomy timing on outcome after severe head injury. Neurocrit Care 2011; 15:481–489.

    Article  Google Scholar 

  6. 6

    Sabouri M, Esmaili TM, Hosseini B. The effects of early tracheostomy on outcomes of patients with severe head injury. J Isfahan Med School 2009; 27:211–216.

    Google Scholar 

  7. 7

    Dunham CM, Cutrona AF, Gruber BS, Calderon JE, Ransom KJ, Flowers LL. Early tracheostomy in severe traumatic brain injury: evidence for decreased mechanical ventilation and increased hospital mortality. Int J Burns Trauma 2014; 4:14–24.

    PubMed  PubMed Central  Google Scholar 

  8. 8

    Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma 2004; 57:251–254.

    Article  Google Scholar 

  9. 9

    Sugerman HJ, Wolfe L, Pasquale MD, Rogers FB, O’Malley KF, Knudson M, et al. Multicenter, randomized, prospective trial of early tracheostomy. J Trauma 1997; 43:741–747.

    CAS  Article  Google Scholar 

  10. 10

    Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 2005; 330: 1243.

    Article  Google Scholar 

  11. 11

    Zirpe KG, Tambe DV, Deshmukh AM, Gurav SK. The impact of early tracheostomy in neurotrauma patients: a retrospective study. Indian J Crit Care Med. 2017; 21:6–10.

    Article  Google Scholar 

  12. 12

    Lee YC, Wang HC, Hsu CL, Wu HD, Hsu HS, Kuo CD. The importance of tracheostomy to the weaning success in patients with conscious disturbance in the respiratory care center. J Chin Med Assoc. 2016; 79:72–76.

    Article  Google Scholar 

  13. 13

    Sanabria A, Gomez X, Vega V, Dominguez LC, Osorio C. Prediction of prolonged mechanical ventilation in patients in the intensive care unit: a cohort study. Colomb Med (Cali). 2013; 44:184–188.

    Article  Google Scholar 

  14. 14

    Lim C-K., Ruan S-Y., Lin F-C., Wu CL, Chang HT, Jerng JS, et al. Effect of tracheostomy on weaning parameters in difficult-to-wean mechanically ventilated patients: a prospective observational study. PLoS One 2015; 10:e0138294.

    Article  Google Scholar 

  15. 15

    Nieszkowska A, Combes A, Luyt CE, Ksibi H, Trouillet JL, Gibert C, Chastre J. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005; 33:2527–2533.

    Article  Google Scholar 

  16. 16

    Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM. Early tracheostomy for primary airway management in the surgical critical care setting. Surgery 1990; 108:655–659.

    CAS  PubMed  Google Scholar 

  17. 17

    Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004; 32:1689–1694.

    Article  Google Scholar 

  18. 18

    Pogue MD, Pecaro BC. Safety and efficiency of elective tracheostomy performed in the intensive care unit. J Oral Maxillofac Surg. 1995; 53:895–897.

    CAS  Article  Google Scholar 

  19. 19

    Vargas M, Sutherasan Y, Antonelli M, Brunetti I, Corcione A, Laffey JG, et al. Tracheostomy procedures in the intensive care unit: an international survey. Crit Care 2015; 19:291.

    Article  Google Scholar 

  20. 20

    Wang HK, Lu K, Liliang PC, Wang KW, Chen HJ, Chen TB, Liang CL. The impact of tracheostomy timing in patients with severe head injury: an observational cohort study. Injury 2012; 43:1432–1436.

    Article  Google Scholar 

  21. 21

    Koch T, Hecker B, Hecker A, Brenck F, Preuß M, Schmelzer T. Early tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: a randomized study. Langenbecks Arch Surg. 2012; 397:1001–1008.

    Article  Google Scholar 

  22. 22

    Siempos II, Ntaidou TK, Filippidis FT, Choi AM. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med. 2015; 3:150–158.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ahmed Ezzat Mohamed Saleh MSc.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Roushdy, M.M., Abdel-Ghaffar, H.S. & Saleh, A.E.M. Does early tracheostomy affect the duration of mechanical ventilation in patients with severe traumatic head injuries?. Egypt J Otolaryngol 34, 127–131 (2018). https://doi.org/10.4103/ejo.ejo_76_17

Download citation

Keywords

  • early tracheostomy
  • head trauma
  • mechanical ventilation