The Role of eaRly The Role of eaRly TRacheosTomy in seveRe TRacheosTomy in seveRe

head injuRieshead injuRies

National Neurosurgical Referral CentreNational Academy of Medical Sciences

Bir Hospital, Kathmandu, Nepal

Prashant kaushalProf Pawan kumar

TRacheosTomy

One of the earliest life saving procedures.

Indication changing with the change of critical care practice.

Improving intensive care has either reduced or delayed the indication for tracheostomy.

Any role of early tracheostomy still?

objecTives

Determine the role of early tracheostomy Determine the role of early tracheostomy in outcome of severe head injuryin outcome of severe head injury

indicaTions

Anticipated prolonged mechanical Anticipated prolonged mechanical ventilation.ventilation.

To facilitate tracheo-bronchial toileting.To facilitate tracheo-bronchial toileting.

sTudy design

Retrospective study Retrospective study

October 2005 to Oct. 2009 at NNRCOctober 2005 to Oct. 2009 at NNRC. .

Retrospective study Retrospective study

October 2005 to Oct. 2009 at NNRCOctober 2005 to Oct. 2009 at NNRC. .

Study deSign

Inclusion criteria Inclusion criteria –All severe head injuries –All severe head injuries

requiring tracheostomyrequiring tracheostomy

GCS of less than 8 GCS of less than 8

OutcOme meaSureS

Glasgow Outcome Score at three Glasgow Outcome Score at three months.months.

Glasgow Outcome Score at three Glasgow Outcome Score at three months.months.

reSultS

81%

reSultS

age diStributiOn

Procedure

resultsresults:: timingtiming

76%

24%

outcome (favorable )outcome (favorable )

Early groupEarly group Late groupLate group

30.830.8%%

P < 0.001

comPlications

tracheostomy Wound tracheostomy Wound infectioninfection

Incidence of infection Incidence of infection 14 (14 (12.9 12.9 %)%)

Organisms Organisms Pseudomonas Pseudomonas 9 (64.3%)9 (64.3%)KlebsiellaKlebsiella 4 (28.6%)4 (28.6%)Staph. aureus Staph. aureus 1(7.1%) 1(7.1%)

ConClusion

Severe head injuries requiring tracheostomy make significantly better recovery if done early.