Comparing outcomes of early and late tracheostomy in severe traumatic brain injury patient

• Main Author: Ismail, Muhammad Ihfaz
• Format: Thesis
• Language: English
• Published: 2018
• Subjects: R Medicine; RF Otorhinolaryngology
• Online Access: http://eprints.usm.my/56786/1/Dr.Muhammad%20Ihfaz%20Ismail-24%20pages.pdf; http://eprints.usm.my/56786/

Background: Patients with severe traumatic brain injury were expected to have poor GCS recovery and prolonged intubation. Therefore, early tracheostomy procedure was indicated for all severe traumatic brain injury . In view of growing concern regarding the safety and outcome of early tracheostomy on these patients, it was deemed valid and needed to be addressed. Method: This study was conducted to compare the outcomes of early and late tracheostomy in severe traumatic brain injury. This study had recruited only severe TBI patient who were admitted to Neurosurgery High Dependency Unit, Hospital Sultanah Aminah, and among them who had underwent tracheostomy.There were three main outcomes noted; duration on ventilaton, length of NHDU stay and rate of ventilator associated pneumonia Results: Out of 155 patient, 72 (46.5%) were in early tracheostomy group and 83 (53.5%) were in late tracheostomy group. Malay ethnicity contributed 95 (61.3%) participants,composed a majority of the study participants. The mean duration on ventilator use was 2.65(1.57) for ETG and 5.63(2.35) for LTG. While, mean NHDU stay was 4.75(1.98) for ETG and 9.77(2.70) for LTG. Upon independent t-test, early duration of tracheostomy had shown significant outcome in reducing length of NHDU stay, (p<0.004) and had shortened duration on mechanical ventilator (p<0.001). Then, from ETG, 69(95.8%) participants had no VAP, and 3(4.2%) had VAP, while for LTG 67(80.7%) had no VAP and 16(19.3%) had VAP. Upon Pearson chi-square test, an association was found between the early tracheostomy in reducing the rate of VAP (p= 0.004). Conclusion: In this study it was found that early tracheostomy was significant in shortening the duration on ventilator, reducing the length of NHDU stay and reducing the rate of ventilator associated pneumonia.