The Role of Early Tracheostomy in Severe Head Injuries - Dr. Rajiv Jha (Neurosurgeon Nepal)
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Transcript of The Role of Early Tracheostomy in Severe Head Injuries - Dr. Rajiv Jha (Neurosurgeon Nepal)
The Role of eaRly The Role of eaRly TRacheosTomy in seveRe TRacheosTomy in seveRe
head injuRieshead injuRies
National Neurosurgical Referral CentreNational Academy of Medical Sciences
Bir Hospital, Kathmandu, Nepal
Prashant kaushalProf Pawan kumar
TRacheosTomy
One of the earliest life saving procedures.
Indication changing with the change of critical care practice.
Improving intensive care has either reduced or delayed the indication for tracheostomy.
Any role of early tracheostomy still?
objecTives
Determine the role of early tracheostomy Determine the role of early tracheostomy in outcome of severe head injuryin outcome of severe head injury
indicaTions
Anticipated prolonged mechanical Anticipated prolonged mechanical ventilation.ventilation.
To facilitate tracheo-bronchial toileting.To facilitate tracheo-bronchial toileting.
sTudy design
Retrospective study Retrospective study
October 2005 to Oct. 2009 at NNRCOctober 2005 to Oct. 2009 at NNRC. .
Retrospective study Retrospective study
October 2005 to Oct. 2009 at NNRCOctober 2005 to Oct. 2009 at NNRC. .
Study deSign
Inclusion criteria Inclusion criteria –All severe head injuries –All severe head injuries
requiring tracheostomyrequiring tracheostomy
GCS of less than 8 GCS of less than 8
OutcOme meaSureS
Glasgow Outcome Score at three Glasgow Outcome Score at three months.months.
Glasgow Outcome Score at three Glasgow Outcome Score at three months.months.
reSultS
81%
reSultS
age diStributiOn
Procedure
resultsresults:: timingtiming
76%
24%
outcome (favorable )outcome (favorable )
Early groupEarly group Late groupLate group
30.830.8%%
P < 0.001
comPlications
tracheostomy Wound tracheostomy Wound infectioninfection
Incidence of infection Incidence of infection 14 (14 (12.9 12.9 %)%)
Organisms Organisms Pseudomonas Pseudomonas 9 (64.3%)9 (64.3%)KlebsiellaKlebsiella 4 (28.6%)4 (28.6%)Staph. aureus Staph. aureus 1(7.1%) 1(7.1%)
ConClusion
Severe head injuries requiring tracheostomy make significantly better recovery if done early.