Early tracheostomy versus, prolonged endotracheal intubation in severe head injury

Background: To see if early tracheostomy (fifth day) reduces duration of mechanical ventilation, ICU stay, incidence of pneumonia and mortality in comparison with prolonged intubation (PI) in patients with head injury. Methods: Patients were prospectively included in this study if they met the following criteria: isolated head injury, Glasgow coma scale (GCS) score ≤8 on first and fifth day, with cerebral contusion on CT scan. On the fifth day, randomization was done in two groups: early tracheostomy group (T group, n = 31) and prolonged endotracheal intubation group (I group, n = 31). We evaluated total time of mechanical ventilation, ICU stay, pneumonia incidence and mortality. Complications related to each technique were noted. Analysis of data were performed using Yates and Kruskall Walis tests. p < 0.05 was considered significant. Results: The two groups were comparable in term of age, sex, and Simplified Acute Physiologic Score (SAPS). The mean time of mechanical ventilatory support was shorter in T group (14.5 ± 7.3) versus I group (17.5 ± 10.6) (p = 0.02). After pneumonia was diagnosed, mechanical ventilatory time was 6 ± 4.7 days for ET group versus 11.7 ± 6.7 days for PEI group (p = 0.01). There was no difference in frequency of pneumonia or mortality between the two groups. Conclusions: In severe head injury early tracheostomy decreases total days of mechanical ventilation or mechanical ventilation time after development of pneumonia.