Abstract
Brainstem hemorrhage is presumed to be invariably associated with a poor prognosis in people with spontaneous hypertensive cerebral hemorrhage. The optimal timing of tracheostomy placement in brainstem hemorrhage patients, who generally require endotracheal intubation for airway protection, remains uncertain. Our research aim was to analyze the impact of early tracheostomy versus late tracheostomy on brainstem hemorrhage patients related outcomes and prognostic factors at 30 days. We identified early tracheostomy and how it could benefit the patients with brainstem hemorrhage and ameliorate the predictors of functional recovery at 30 days. Data on 136 patients with brainstem hemorrhage and Glasgow Coma Scale score ≤ 8, were retrospectively collected from 2012 to 2019. Patients were divided into the early tracheostomy group and the late tracheostomy group. Patients in the early tracheostomy group had a significantly lower neurosurgical intensive care unit stay (both overall and survival) compared with the late tracheostomy group (15.6 days vs. 19.0 days, P = 0.041, overall and 14.5 vs. 19.5 days, P = 0.023, survival). Also, the good outcomes (modified Rankin Score ≤ 3) were higher in the early tracheostomy group (P = 0.036). Multivariate analysis demonstrated that less hemorrhagic volume, high Glasgow Coma Scale score on admission, young age, and early tracheostomy were significantly associated with a better 30-day functional outcome. In conclusion, an early tracheostomy in patients with brainstem hemorrhage can reduce neurosurgical intensive care unit stay, and in addition to improvements in prognosis at 30 days.
Highlights
Brainstem hemorrhage (BSH) is a rare neurological illness that accounts for approximately 5~10% of all spontaneous intracranial hemorrhages, the overall mortality rate is high, with a range from 30% to 70%, resulting in survivors with long-term neurological deficits
The hemorrhagic volume was measured by the ABC method on computed tomography (CT) brain scan, in which A means the maximum width in cm assessed on the slice through the most substantial portion of hematoma, B means the maximum length in cm assessed by a line perpendicular to Variables Gender; n (%) male female Age; mean ( ± Standard deviation (SD)) Glasgow Coma Scale (GCS) on admission; mean ( ± SD) Main location of hemorrhage; n (%) pons midbrain Medulla Volume of hemorrhage; n (%) ≤ 10ml > 10ml Hydrocephalus; n (%) Present Absent Operation; n (%) Yes No smoking; n (%) yes no Habitual alcohol consumption; n (%) yes no Pupil; n (%) reactive pinpoint dilated Ventricular extension; n (%) yes no Previous stroke; n (%) yes no
The comparison between the ET group and late tracheostomy (LT) group revealed that patients who were subjected to early tracheostomy had a significantly lower neurosurgical intensive care unit (NICU) stay-overall (15.55 vs. 19.00 days, P = 0.041)
Summary
Brainstem hemorrhage (BSH) is a rare neurological illness that accounts for approximately 5~10% of all spontaneous intracranial hemorrhages, the overall mortality rate is high, with a range from 30% to 70%, resulting in survivors with long-term neurological deficits (Dziewas et al, 2003; Jeong et al, 2002; Wessels et al, 2004; Wijdicks and St. Louis, 1997). With the development in the microsurgery and stereotactic surgery field, the outcome of patients with BSH has been undoubtedly improved (Hara et al, 2001). Observational studies identified poor outcomes such as coma on admission, large hematoma, abnormal respiration, and pupil abnormalities as prognostic indicators (Arabi et al, 2004; Murata et al, 1999; Wijdicks and St. Louis, 1997)
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