Abstract
ObjectiveThe goal of this study was to determine the efficacy of early tracheostomy (i.e., ≤ 10 days of intubation) compared with a late tracheostomy (> 10 days of intubation) with regards to timing, frequency of ventilator-associated pneumonia (VAP), mortality rate, and hospital stay in patients who received decompressive craniectomy.Study designWe conducted a retrospective study of data from 168 patients who underwent decompression in the department of critical care medicine at Shifa International Hospital, Islamabad, Pakistan, from January 2017 to December 2017.Materials and methodsThe study included men and women over the age of 18 years who had undergone tracheostomy following decompressive craniectomy in the intensive care unit as a result of stroke, traumatic brain injury, or acute severe injury. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, US). We also applied the Chi-square test, and p ≤ 0.05 was considered significant.ResultsOf 168 patient records reviewed, tracheostomy was performed in 48 patients (21 men, 27 women). In the 48 tracheostomy patients, 15 (31%) were early tracheostomies and 33 (69%) were late tracheostomies. The mean age of patients was 44 ± 11 years. Twenty-eight patients (58.3%) were in the younger age group (age 18 to 45 years) and 20 patients (41.7%) were in the older age group (age > 45 years). Patients who received an early tracheostomy spent significantly less time on a ventilator (≤ 12 days) than those patients receiving a late tracheostomy (> 12 days, p = 0.004). The early tracheostomy group also had a lower incidence rate of VAP than patients with a late tracheostomy (𝑥2 = 7.855, p = 0.005). Patients who received an early tracheostomy had lower mortality rates than those who received late tracheostomies (𝑥2 = 6.158, p = 0.013). Finally, the length of hospital stay was ≤ 15 days for patients who received early tracheostomies; most patients who received a late tracheostomy had a hospital stay of > 15 days (𝑥2 =11.965, p = 0.001).ConclusionsPerforming a tracheostomy within 10 days of intubation following decompressive craniectomy significantly reduced ventilator time, mortality, the incidence of VAP, and length of hospital stay. Given the potential benefits of early tracheostomy in critical care patients following decompressive craniectomy, physicians should consider early tracheostomy in appropriate cases.
Highlights
Tracheostomy is a surgical procedure mostly used in patients requiring long-term mechanical ventilation [1]
This study aims to determine the efficacy of early tracheostomy (≤ 10 days of intubation) compared with a late tracheostomy (> 10 days of intubation) in terms of timing on a ventilator, frequency of ventilatorassociated pneumonia (VAP), mortality rate, and length of hospital stay for patients who undergo decompressive craniectomy
The time spent on a ventilator in days was significantly lower in those receiving an early tracheostomy as compared with ventilator time for patients receiving a late tracheostomy (≤ 12 days versus > 12 days, p=0.004)
Summary
Tracheostomy is a surgical procedure mostly used in patients requiring long-term mechanical ventilation [1]. The procedure exteriorizes the trachea to the skin of the neck, resulting in a permanent fistula or opening. The procedure helps prevent tracheal intubation complications (e.g., ventilator-associated pneumonia (VAP), tracheal stenosis, and sinusitis) [2]. 800,000 acute respiratory patients in the United States undergo tracheostomy each year [3]. How to cite this article Qureshi M, Shad Z, Shoaib F, et al (December 07, 2018) Early Versus Late Tracheostomy After Decompressive Craniectomy. The average number of tracheostomies performed per year in the United States is over 100,000 [5]
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