Effect of tracheal intubation performed by trauma surgeons on patients with severe traumatic brain injury

Abstract

Background: An early intubation is predominantly performed by anesthesiologists for patients experiencing severe traumatic brain injury (STBI). Currently, a growing number of trauma surgeons in China have acquired proficient skills in tracheal intubation through rigorous training offered at trauma centers. In this article, we performed a retrospective observational cohort investigation with the aim of comparing the outcomes of endotracheal intubation conducted by trauma surgeons and anesthesiologists in the emergency room, specifically focusing on patients suffering from STBI. Methods: Data were gathered from all STBI patients who received intubation between January 2018 and March 2023. There are two study groups based on the intubation performers: the trauma surgeon's intubation (TI) group and the anesthesiologist's intubation (AI) group. The age, sex, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), admission SpO2, PO2, PCO2, SBP, RR, HR, injury mechanism, intracranial lesion type, duration of endotracheal intubation, 1-min success rate of intubation, complications related to intubation, time from admission to intubation, duration of mechanical ventilation, incidence of aspiration pneumonia, 3-day mortality rate and the 30-day mortality rate were recorded. Results: Among the 356 patients with STBI, 219 individuals fulfilled the inclusion criteria (comprising of 142 patients in the TI group and 77 patients in the AI group). No notable statistical differences were observed between the two groups in terms of age, sex, ISS, GCS, admission SpO2, PO2, PCO2, SBP, RR, HR, injury mechanism, and intracranial lesion type. The AI group exhibited a considerably shorter time from admission to intubation (p<0.01). Furthermore, the AI group demonstrated a reduced incidence of aspiration pneumonia as well as a decreased duration of mechanical ventilation (p<0.05). Conclusion: The intubation of patients with STBI by trauma surgeons early can reduce aspiration pneumonia incidents and duration of mechanical ventilation.