Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 21 , ISSUE 1 ( 2017 ) > List of Articles


The impact of early tracheostomy in neurotrauma patients: A Retrospective study

Kapil Zirpe, Deepali Tambe, Sushma K Gurav

Keywords : Early tracheostomy, neurotrauma, traumatic brain injury

Citation Information : Zirpe K, Tambe D, Gurav SK. The impact of early tracheostomy in neurotrauma patients: A Retrospective study. Indian J Crit Care Med 2017; 21 (1):6-10.

DOI: 10.4103/0972-5229.198309

License: CC BY-ND 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2017; The Author(s).


Background: Although majority of neurotrauma patients require long term ventilatory support but the timing of tracheostomy in such patients is controversial. Method: This retrospective study was conducted at a Tertiary Care Hospital, Pune, India. Patients >18 years of age, who underwent percutaneous tracheostomy (PCT) from June 2010 to November 2014 at neurotrauma unit (NTU) of hospital, were included. Patients were divided in two groups according to the timing of tracheostomy, early tracheostomy (ET) group (≤5 days; N=100) and late tracheostomy (LT) group (>5 days; N=64). The nonparametric Mann-Whitney test, and Chi-square tests were used to compare these groups. Result: There were no significant differences between the groups in terms of age, sex, APACHE II and GCS Score. Patients in the ET group had a significantly shorter stay in the NTU compared to patients in the LT group (mean, 18 vs. 21.2 days, p=0.005), fewer mechanical ventilation days (mean, 8.1 vs. 11.7 days, P=0.000) and shorter length of stay in hospital (mean, 28.8 vs. 34.37 days, P=0.019). There was no difference between ET and LT groups in post PCT ventilator free days (mean, 8.2 vs. 9.4 days; P=0.094). Mortality rates in ET vs. LT groups were also comparable (35% vs. 29.7%; P=0.480). Conclusion: Results suggest that ET in neurotrauma patients might be associated with shorter length of stay in NTU and hospital, and shorter duration of mechanical ventilation however there was no mortality difference.

PDF Share
  1. Andriolo BN, Andriolo RB, Saconato H, Atallah ÁN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev 2015;1:CD007271.
  2. Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med 2000;161:1450-8.
  3. Durbin CG Jr. Tracheostomy: Why, when, and how? Respir Care 2010;55:1056-68.
  4. Shan L, Hao P, Xu F, Chen YG. Benefits of early tracheotomy: A meta-analysis based on 6 observational studies. Respir Care 2013;58:1856-62.
  5. Mahafza T, Batarseh S, Bsoul N, Massad E, Qudaisat I, Al-Layla AE. Early vs. late tracheostomy for the ICU patients: Experience in a referral hospital. Saudi J Anaesth 2012;6:152-4.
  6. Young D, Harrison DA, Cuthbertson BH, Rowan K; TracMan Collaborators. Effect of early vs. late tracheostomy placement on survival in patients receiving mechanical ventilation: The TracMan randomized trial. JAMA 2013;309:2121-9.
  7. Cheung NH, Napolitano LM. Tracheostomy: Epidemiology, indications, timing, technique, and outcomes. Respir Care 2014;59:895-915.
  8. Chintamani, Khanna J, Singh JP, Kulshreshtha P, Kalra P, Priyambada B, et al. Early tracheostomy in closed head injuries: Experience at a tertiary center in a developing country - A prospective study. BMC Emerg Med 2005;5:8.
  9. Rizk EB, Patel AS, Stetter CM, Chinchilli VM, Cockroft KM. Impact of tracheostomy timing on outcome after severe head injury. Neurocrit Care 2011;15:481-9.
  10. Wang HK, Lu K, Liliang PC, Wang KW, Chen HJ, Chen TB, et al. The impact of tracheostomy timing in patients with severe head injury: An observational cohort study. Injury 2012;43:1432-6.
  11. Alali AS, Scales DC, Fowler RA, Mainprize TG, Ray JG, Kiss A, et al. Tracheostomy timing in traumatic brain injury: A propensity-matched cohort study. J Trauma Acute Care Surg 2014;76:70-6.
  12. Ahmed N, Kuo YH. Early versus late tracheostomy in patients with severe traumatic head injury. Surg Infect (Larchmt) 2007;8:343-7.
  13. Pinheiro Bdo V, Tostes Rde O, Brum CI, Carvalho EV, Pinto SP, Oliveira JC. Early versus late tracheostomy in patients with acute severe brain injury. J Bras Pneumol 2010;36:84-91.
  14. Gessler F, Mutlak H, Lamb S, Hartwich M, Adelmann M, Platz J, et al. The impact of tracheostomy timing on clinical outcome and adverse events in poor-grade subarachnoid hemorrhage. Crit Care Med 2015;43:2429-38.
  15. Paydar S, Khalili H, Mousavi SM. Perfect timing of tracheostomy in patients with traumatic brain injury. Bull Emerg Trauma 2014;2:136-7.
  16. Victoria AM, Aziz SA, Damon CS, Neil KJ Adhikari, Gordon DR, Brain HC, et al. Effects of early versus late tracheostomy or prolonged intubation in critically ill patient with acute brain injury: A systematic review and meta-analysis Neurocrit care 2016. DOI 10.1007/s12028-016-0297-z.
  17. Siddiqui UT, Tahir MZ, Shamim MS, Enam SA. Clinical outcome and cost effectiveness of early tracheostomy in isolated severe head injury patients. Surg Neurol Int 2015;6:65.
  18. Dunham CM, Cutrona AF, Gruber BS, Calderon JE, Ransom KJ, Flowers LL. Early tracheostomy in severe traumatic brain injury: Evidence for decreased mechanical ventilation and increased hospital mortality. Int J Burns Trauma 2014;4:14-24.
  19. Siempos II, Ntaidou TK, Filippidis FT, Choi AM. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: A systematic review and meta-analysis. Lancet Respir Med 2015;3:150-8.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.