An Audit of Tracheostomy in Traumatic Brain Injury

The timing of tracheostomy in traumatic brain injury is controversial. The benefits of early tracheostomy are early weaning from ventilation, and reduction in pneumonia. But some studies demonstrated increase in intracranial pressure during tracheostomy.

The aims of the audit are to analyse the timing, benefits, complications, and the results of tracheostomy in patients with traumatic brain injury in the hospital in the period of 2012-2021.

The number of patients was 34. The maximum number of tracheostomies(24) were between 6th to 14th days of admission. The complications were: worsening of Glasgow coma scale score - 3 (in the early group), bleeding - 2, subglottic stenosis-1, tracheocutaneous fistula-1. The main benefits obtained form tracheostomy were the easiness of weaning and tracheobronchial toilet. Twelve patients had pneumonia. Nine patients survived out of twelve. Six patients had acute respiratory distress syndrome. Five of them succumbed. The weaning time corresponded to the severity of injury and pulmonary status. The mortality according to the timing of tracheostomy were: 1/6(16.67%) in the group of first week, 9/19(47%) in the group of second week, and 3/8(37.5%) in the group of the third and fourth week. The mortality was less in the group of first week.

The timing of tracheostomy in traumatic brain injury should be at the earliest after the control of raised intracranial tension. There was reversible worsening of Glasgow coma scale score for 2 points in 3 cases after early tracheostomy. Mortality was less in the group of early tracheostomy.