This document presents a prospective randomized trial comparing early versus late tracheostomy in traumatic brain injury patients. The study involved 50 patients randomized into two groups: those receiving early tracheostomy within 5 days of mechanical ventilation (Group A, n=25) and those receiving late tracheostomy after 5 days (Group B, n=25). The study found no significant differences between the two groups in average ICU stay duration, average ventilation duration, or average mortality rate. The conclusion is that early and late tracheostomy did not significantly differ in these outcomes for traumatic brain injury patients requiring mechanical ventilation. Further multicenter studies are needed to better understand the benefits of early tracheostomy.

1. Presenter: Ms Mary Teenu, Staff nurse, NIS, JPNATC
Guide: Dr. Deepak Agrawal, Addl. Professor, Deptt of Neurosurgery,
JPNATC

2. PROBLEM STATEMENT
 A prospective randomized trial to compare
early versus late tracheostomy in traumatic
brain injury patients.

3. INTRODUCTION
 A majority of patients with severe traumatic
brain injury need ventilatory support and
require endotracheal intubation.
 Percutaneous tracheostomy is a common
procedure in critically ill patients, but the
correct timing is still controversial.

4. OPERATIONAL DEFINITION
Early tracheostomy
• Percutaneous tracheostomy when
performed within 5 days of mechanical
ventilation
Late tracheostomy:
• Percutaneous tracheostomy when
performed after 5 days of mechanical
ventilation

5. OBJECTIVES
 To compare duration of ICU stay in early
tracheostomy and late tracheostomy patients
 To compare duration of ventilation in early
tracheostomy and late tracheostomy patients
 To compare mortality rate in early tracheostomy
and late tracheostomy patients

7. RESEARCH DESIGN
Quantitative
Prospective
Study

8. STUDY PERIOD
6 months
(November 2012-
April 2013)

9. SITE
 All India Institute of Medical Sciences, New
Delhi

10. SETTING
 Neurosurgery ICU, JPNATC, AIIMS

11. SAMPLING METHOD
Simple
Random
Sampling

12. POPULATION
Traumatic brain
injury patients
who require
mechanical
ventilation

13. SAMPLE SIZE
50 traumatic brain
injury patients who
required mechanical
ventilation

14. SUBJECT ALLOCATION
 Out of the 50 subjects
• (early
tracheostomy)25 were in
group A
• (late
tracheostomy)25 were in
group B

15. INCLUSION CRITERIA
 TBI patients who are admitted in
neurosurgery ICU, JPNATC, AIIMS
 TBI patients who require mechanical
ventilation
 Patients who are 18 years or above

16. EXCLUSION CRITERIA
Patients below 18
years of age

17. RESULTS

18. MEAN AGE
GROUPS Mean age (range)
Group A 32.4 yrs (19-55yrs)
Group B 30 yrs (20-54yrs)
N=50

19. GENDER DISTRIBUTION
18
20
7
5
0
5
10
15
20
25
Group A (n=25) Group B (n=25)
NUMBEROFMALESAND
FEMALES
Male
Female
72%
28%
80%
20%
N=50

20. AVERAGE DURATION OF ICU STAY
14.16
14.28
14.1
14.12
14.14
14.16
14.18
14.2
14.22
14.24
14.26
14.28
14.3
Group A (n=25) Group B (n=25)
NUMBEROFDAYS
Average duration of ICU stay
Average duration of ICU stay
N=50
p=0.14

21. AVERAGE DURATION OF VENTILATION
Average duration of
ventilation
Group A (n=25) 12.45 DAYS
Group B (n=25) 13.8 DAYS
N=50
p=1.30

22. AVERAGE MORTALITY RATE
Average mortality
rate
Group A (n=25) 2%
Group B (n=25) 1%
N=50

23. CONCLUSION
 Early and late tracheostomy did not
significantly differ in length of ICU stay,
duration of ventilation and mortality rate
 Further multicentre study should be
conducted to further identify benefits of
early tracheostomy

24. Thank you