Comparative Study between Early Tracheostomy and Extended Endotracheal Intubation in Severe Head Injury

BACKGROUND: The optimal tracheostomy time is considered a debatable issue for patients with severe Head injury in intensive care units [ICUs], which require mechanical ventilation [MV] for long period. THE AIM OF THE WORK: The current study aimed to investigate the effect of tracheostomy operation in early few days of admission on the length of mechanical ventilation [MV]. In addition, to determine outcomes and associated mortality rate.PATIENTS AND METHODS: a prospective randomized Comparative clinical study included 200 patients admitted to ICU units of Al-Azhar university hospitals and El Haram hospital who had the following criteria: severe head injury, Cerebral trauma on and Glasgow Coma Scale [GCS]score 8 or less on the fourth day viewed by brain CT scan done without given any sedation. Divided into 2 groups on the fourth day of admission each group includes 100 patients, one group submitted to early Tracheostomy [ET] [group A] and the other group submitted to extended endotracheal intubation[EEI] [group B].RESULTS: There was shorter in the main period of the mechanical ventilatory support for group A than group B with statistically significant relationship p value=0.02.Their no remarkable difference in the occurrence of Nosocomial pneumonia between group A and group B. p value of Nosocomial pneumonia = 0.62. CONCLUSION: In severe head injury, ET significantly decreases the mechanical ventilation time.