The impact of tracheostomy timing in patients with severe head injury: An observational cohort study

Abstract

Study designA retrospective analysis of 66 adults with severe head injury admitted to the neurosurgical intensive care unit (ICU) who required tracheostomy. ObjectiveThe purpose of this cohort study was to examine the impact of the tracheostomy timing in patients with severe head injury. MethodsPatients were included in this study if they were admitted to the neurosurgical ICU because of severe head injury and if tracheostomy was performed. The patients were classified into 2 groups: early tracheostomy (ET) and late tracheostomy (LT). The timing of tracheostomy was considered early if it was performed by day 10 of mechanical ventilation and late if it was performed after day 10. We compared the duration of mechanical ventilation, length of stay (LOS) at ICU, hospital LOS, incidence of pneumonia, duration of antibiotics use, and mortality between the ET and LT groups. ResultsOf the 2481 patients with severe head injury admitted to the neurosurgical ICU, 66 (2.7%) required tracheostomy; 16 of whom were in the ET group and 50 were in the LT group. The ICU LOS was significantly shorter in the ET group (p<0.001). The incidence of nosocomial pneumonia was lower in the ET group (p=0.04) and the duration of antibiotic use was significantly shorter in the ET group (p<0.001). The patients in the ET group had a lower incidence of pneumonia caused by gram-negative microorganisms (p=0.001). ConclusionsET in patients with severe head injury might contribute to a shorter duration of ICU LOS, lower incidence of gram-negative microorganism-related nosocomial pneumonia, and shorter duration of antibiotic use.