Abstract
ObjectivePatients with severe brain injury is usual at high risk of extubation failure, despite of those with no/minor primary respiratory problem, majority of them still needs long term respiratory support and has severe pulmonary complications. This retrospective study aimed to compare the effect of noninvasive ventilation (NIV) and tracheotomy on the prognosis in critically ill mechanically ventilated neurosurgical patients.MethodsThis is a single center, retrospective observe cohort study. Postoperative patients with brain injury consecutively admitted to ICU from November 1st, 2015 through February 28th, 2017, who had received invasive mechanical ventilation more than 48 h were screened, those who received NIV or tracheotomy procedure, meanwhile with Glasgow Coma Scale (GCS) score between 8 and 13 points before using NIV or undergoing tracheotomy, were retrospectively included in this study. The demographic data and clinical main outcomes such as ICU and hospital mortality, time of mechanical ventilation, length of ICU and hospital were collected. The primary outcome was the incidence of postoperative pulmonary infection between two groups.Results77 patients were included in this study. 33 patients received NIV, and 44 patients received tracheotomy through the ICU duration. The incidence of postoperative pulmonary infection in NIV group was significantly lower than that in tracheotomy group (54.5% VS 84.1%, P < 0.05), Application of NIV was associated with shorter duration of invasive mechanical ventilation ([median 123.0 h VS 195.0 h, P < 0.05). Moreover, GCS score at ICU discharge, as well as the difference of GCS score between at admission to ICU and ICU discharge were also better than the tracheotomy group (P < 0.001).ConclusionCompared with tracheotomy, use of NIV after extubation in critically ill mechanically ventilated neurosurgical patients may be associated with lower incidence of postoperative pulmonary infection, shorter duration of invasive mechanical ventilation and better improvement in brain function. Further studies need to verify the effect of NIV in this kind of patients.
Highlights
Brain injury is a growing problem of public health and social economy in the world
A total of 1278 patients admitted to SICU and NICU in our hospital from November 2015 to February 2017 were screened. 77 patients were enrolled in this study including 33 patients who had only used noninvasive ventilation (NIV) (NIV group) and 44 patients who had only undergone tracheotomy after invasive mechanical ventilation
The level of consciousness and the criticality of the patient were similar between two groups, with no significant differences of APACHE Acute Physiology and Chronic Health Evaluation (II) score and Glasgow Coma Scale (GCS) score before NIV or tracheotomy were observed between two groups
Summary
In United States, about 235,000 patients are admitted to hospital every year because of traumatic brain injury, and the annual death toll is about 50,000. The total cost of hospitalization due to traumatic brain injury in 2010 amounted $21 billion to 400 million [1, 2]. In China, the incidence of traumatic brain injury in the age of over 65 years has increased by 7.78% annually, with an average hospitalization cost of $795 and a fatality rate of 9.38% [3]. In order to maintain respiration, optimize oxygenation and protect airway, patients with brain injury usually need Mechanical Ventilation (MV) in ICU. Previous studies have shown that long-term mechanical ventilation were associated with a lot of pulmonary complications in patients with severe brain injury, such as ventilator-associated lung injury, pulmonary infection, diaphragm dysfunction, pulmonary embolism and so on, and increased the mortality of disease [5]. Relevant studies demonstrated that, in brain-injured patients,the incidence of pulmonary infection was 20%, the rate of reintubation caused by extubation failure was from 10 to 15%, and the incidence of pneumonia after extubation failure was as high as 85% [6,7,8]
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