National Neurosurgical Referral CentreNational Academy of Medical Sciences Bir Hospital, Kathmandu, Nepal

1. The Role of eaRlyThe Role of eaRly
TRacheosTomy in seveReTRacheosTomy in seveRe
head injuRieshead injuRies
National Neurosurgical Referral Centre
National Academy of Medical Sciences
Bir Hospital, Kathmandu, Nepal
Prashant kaushal
Prof Pawan kumar

2. 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?

3. objecTives
Determine the role of early tracheostomyDetermine the role of early tracheostomy
in outcome of severe head injuryin outcome of severe head injury

4. indicaTions
 Anticipated prolonged mechanicalAnticipated prolonged mechanical
ventilation.ventilation.
 To facilitate tracheo-bronchial toileting.To facilitate tracheo-bronchial toileting.

5. sTudy design
 Retrospective studyRetrospective study
 October 2005 to Oct. 2009 at NNRCOctober 2005 to Oct. 2009 at NNRC..
 Retrospective studyRetrospective study
 October 2005 to Oct. 2009 at NNRCOctober 2005 to Oct. 2009 at NNRC..

6. Study deSign
 Inclusion criteriaInclusion criteria –All severe head injuries–All severe head injuries
requiring tracheostomyrequiring tracheostomy
 GCS of less than 8GCS of less than 8

7. OutcOme meaSureS
Glasgow Outcome Score at threeGlasgow Outcome Score at three
months.months.
Glasgow Outcome Score at threeGlasgow Outcome Score at three
months.months.

8. reSultS
81%

9. reSultS

10. age diStributiOn

11. Procedure

12. resultsresults::timingtiming
76%
24%

13. outcome (favorable )outcome (favorable )
Early groupEarly group Late groupLate group
30.830.8 %%
P < 0.001

14. comPlications

15. tracheostomy Woundtracheostomy Wound
infectioninfection
 Incidence of infectionIncidence of infection 14 (14 (12.912.9 %)%)
 OrganismsOrganisms
PseudomonasPseudomonas 9 (64.3%)9 (64.3%)
KlebsiellaKlebsiella 4 (28.6%)4 (28.6%)
Staph. aureusStaph. aureus 1(7.1%)1(7.1%)

16. ConClusion
Severe head injuries requiring
tracheostomy make significantly
better recovery if done early.