Airway problems in patients with traumatic brain injury

It has become an accepted practice to perform endotracheal intubation on patients who are comatose as a result of traumatic brain injury; and if the comatose state persists, a surgical tracheotomy is performed. There are inherent risks associated with both of these procedures. Of 44 patients with traumatic brain injury admitted to the author's rehabilitation unit, ten required endotracheal intubation only; in 32, endotracheal intubation was followed by tracheotomy; and two required immediate tracheotomies. Clinically detectable laryngotracheal pathology developed in five patients; four patients did not tolerate decannulation and were discharged with tracheotomies; and two patients required reintubation because of recurrent pneumonias. Surgical intervention was necessary in three patients; one patient was extubated two years after injury; and seven remain with tracheotomy. The management of these complications and principles of tracheotomy care are discussed. The literature is reviewed to gain a better understanding of these problems. Anticipation of these complications should prevent possible life-threatening consequences.