The Impact of Tracheostomy Timing (Early and Late) on Severe Head Injury Patients Toward Clinical Outcomes

Abstract

Introduction: Severe head injury patients require a specific treatment plan and nursing care to achieve an optimal clinical outcome. Mild head injury patients may need a few days of hospitalisation for close monitoring and conservative medical administrations. However, in severe head injury cases, the patients may require a more extended period of hospitalisation for a series of complex neuro-medical and neurosurgical management. Tracheostomy may be performed on head injury patients with protracted breathing problems. Early tracheostomy (ET) may improve clinical outcomes  late tracheostomy. ET is defined as the tracheostomy done seven days after the initiation of endotracheal intubation. Objective : The objective of this study is to determine the impact of ET on a patient's clinical outcome before being discharged. Methodology: This is a retrospective cohort study involving 45 severe head injury patients with tracheostomy done in two Neuro-Centre hospitals in Klang Valley. The clinical outcome was observed before the participants are discharged including the participant's GCS upon discharge, length of stay (LOS) in the ICU and hospital, the incidence of VAP, duration of mechanical ventilation dependency, and decannulation rate. Findings: There are 45 participants in this study as the sample. Crude analysis performed in this study showed that there is a significant association between tracheostomy classification (early and late) toward participant length of stay in the ICU with a p-value of <0.001, LOS in the hospital (p=0.002), and duration on the mechanical ventilation use (p<0.001) with no association with the GCS upon discharge (p=0.057), the incidence of VAP (p=0.374), and decannulation rate (p=0.081).Potential confounding factors in this study were determined statistically. It was done by comparing the model without an additional factor and the model with an additional factor. Multivariate analysis showed that the association between these variables remained significant for the LOS in the hospital (p=0.035) and duration of mechanical ventilation used (p=0.005). Conclusion: The initiation of ET contributes to a favourable clinical outcome in terms of the duration of mechanical ventilation and length of hospital stay for patients with a severe head injury. However, the association between tracheostomy categorisation and ICU LOS, incidence of pneumonia, decannulation rate, and GCS at discharge was not statistically significant.