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Early translaryngeal tracheostomy in patients with severe brain damage

N Stocchetti1, A Parma, V Songa

  • 1Department Anesthesia and Intensive Care, Neuroscience Intensive Care, Policlinico Hospital IRCCS, Milan, Italy. stocchet@polic.cilea.it

Intensive Care Medicine
|October 13, 2000
PubMed

Insights

Early translaryngeal tracheostomy can temporarily increase intracranial pressure in neurocritical care patients. Careful patient selection and neuromonitoring are essential for safe and effective translaryngeal tracheostomy.

Area of Science:

  • Neurosurgery
  • Critical Care Medicine
  • Respiratory Physiology

Background:

  • Intracranial pressure (ICP) management is critical in neurocritical care.
  • Tracheostomy is often necessary for prolonged mechanical ventilation.
  • The effects of early translaryngeal tracheostomy on intracranial dynamics require investigation.

Purpose of the Study:

  • To assess the impact of early translaryngeal tracheostomy on ICP, cerebral perfusion pressure (CPP), and jugular bulb saturation (SjO2).
  • To identify mechanisms influencing ICP during the procedure.
  • To evaluate long-term tracheal anatomy and function post-tracheostomy.

Main Methods:

  • Prospective, observational clinical study in a neurosurgical intensive care unit.
  • 20 patients with severe neurological injury (Glasgow Coma Scale < 8) underwent translaryngeal tracheostomy.
  • Continuous neuromonitoring, including ICP, CPP, and SjO2, was performed.

Main Results:

  • A significant ICP increase (p < 0.05) occurred during cannula placement, with 5 patients developing intracranial hypertension.
  • CPP remained stable in most patients; no significant rise in PaCO2 was observed.
  • Three months post-tracheostomy, tracheoscopy revealed normal findings in all examined patients.

Conclusions:

  • Early translaryngeal tracheostomy is generally well-tolerated in selected neurocritical care patients.
  • The procedure can transiently affect ICP, necessitating careful monitoring and patient selection.
  • No persistent intracranial disorders or significant long-term tracheal damage were detected.
Abstract

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