Authors
1 FIBMS Candidate
2 MB,ChB, DLO, FIBMS in ORL-H&N Surgery
3 AlSadr Teaching Hospital, Basrah, IRAQ.
Abstract
AbstractTracheostomy is a surgical procedure that frequently performed for patients in the intensive care units (ICUs). Prolonged mechanical ventilation (MV) is the main indication for tracheostomy in the ICU.This study aimed to compare the effect of early versus late tracheostomy on duration of mechanical ventilation and ICU length of stay in traumatic brain injury patients and to determine the appropriate timing to perform tracheostomy for those patients.A Prospective comparative study was performed for head trauma patients with Glasgow coma scale (GCS) less than eight who needed endotracheal intubation with or without mechanical ventilation in the ICU of Al-Sadr Teaching Hospital in Basrah from February 2019 up to December 2019.In this study, there were 94% males and 6% females, 52% were in the age group between 20-40 years, median duration on endotracheal tube in early tracheostomy (ET) group was 5 days while in late tracheostomy (LT) group was 11 days. Total duration on MV was significantly shorter in ET group (9.63±1.87 versus 17.81±6.66 days in LT group; p<0.05). Post tracheostomy MV duration was shorter in ET (6.23±1.48 versus 10.69±4.34 days p<0.05). The ICU length of stay also was significantly shorter in early group (12.70±1.80 versus 22.37±7.19 days; p<0.05).In conclusion; early tracheostomy in traumatic brain injury before 7 days from endotracheal intubation significantly shortens the duration of mechanical ventilation and ICU length of stay.
Keywords
Introduction racheostomy is the creation of an opening on the surface of skin that's leads to tracheal lumen1 . The history of tracheostomy is long and storied. The earliest accounts of a procedure that resembling tracheostomy was found in Egyptian papers that dated back to 3600 BC2 . In most instances, endotracheal intubation is used for short-term airway protection and/or ventilation, but tracheostomy is indicated in certain conditions3 : prolonged mechanical ventilation, pulmonary toilet, upper air way obstruction, and as a part of another procedure (in major head and neck procedures in which it is necessary to remove the whole larynx, a permanent tracheostomy is an unavoidable consequence). Traumatic Brain Injuries (TBI) is an alteration in brain function, or other evidence of brain pathology, caused by an external force. The alteration in brain function consists of any period of loss of or a decreased of consciousness level, any anterograde or retrograde amnesia, neurologic deficits or any alteration in mental state at the time of the injury4 . Head injuries most often have been classified by one of three main systems5 : Clinical indices of severity; used most often in clinical research to compare patients among centres. Pathoanatomic type; used most often to describe injuries for acute management. Physical TThe effect of early versus late tracheostomy Doaa M abdulsamad, Abdulrazzaq H Alrubaiee & Duraid A Altameemi Bas J Surg,June, 27, 2021 46 mechanism; describe the causative forces associated with the injury, used most often in the biomechanics and prevention fields. Patients and methods A prospective comparative clinical study was designed to compare the difference in duration of mechanical ventilation and intensive care unit length of stay (LOS) among head trauma patients to whom early tracheostomy (ET) was done and those to whom late tracheostomy (LT) was performed. The study was performed for head trauma patients in the ICU at AlSadr Teaching Hospital in Basrah, Iraq, during the period from February 2019 up to December 2019. Approval from Arabic Board of Medical Specialty was acquired. Informed consent was taken from patients families. Inclusion criteria were: Head trauma patients with Glasgow Coma Scale (GCS) five to eight who were on endotracheal tube (ETT) with or without mechanical ventilation, all age groups, and both genders were involved in this study. Exclusion criteria: GCS four and less, patients with respiratory problems (bronchial asthma and chronic obstructive pulmonary disease), patients with chest trauma, coagulation disorders, and loss of follow-up. The decision about the need for tracheostomy was related to opinion of attending neurosurgeon, ICU anaesthesiologist, and otolaryngologist. The patients were divided into two groups according to the timing of tracheostomy; early tracheostomy group: Those patients to whom tracheostomy was done at less than seven days from endotracheal intubation. Late tracheostomy group: Those patients to whom tracheostomy was done at or after seven days from endotracheal intubation. Tracheostomy procedure was done to all patients by open surgical technique; in operating room under general anaesthesia (all patients already had endotracheal tube). Statistical analysis was done by SPSS23 (statistical package for social science, version 23). Parametric data continuous variables were presented using descriptive statistics which expressed as mean±standard deviation (SD) or as frequencies and percentages and by using student t-test. Chi square test was used to compare between the two groups. Pvalues less than 0.05 were considered significant. Result
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