Early tracheostomy versus prolonged endotracheal intubation in severe head injury.
| Autor: | Bouderka MA; Department of Anesthesiology and Intensive Care Unit (P33), Ibn Rochd Hospital, Casablanca, Morocco. mabouderka@yahoo.fr, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A |
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| Jazyk: | angličtina |
| Zdroj: | The Journal of trauma [J Trauma] 2004 Aug; Vol. 57 (2), pp. 251-4. |
| DOI: | 10.1097/01.ta.0000087646.68382.9a |
| Abstrakt: | 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 < or =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. Conclusion: In severe head injury early tracheostomy decreases total days of mechanical ventilation or mechanical ventilation time after development of pneumonia. |
| Databáze: | MEDLINE |
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