Traumatic brain injury (TBI) is a serious public health concern worldwide that affects nearly 70 million people each year, more than 5 million of whom are considered to have severe injuries. Individuals who sustain severe TBI commonly suffer from a number of health complications that significantly increase their risk of death immediately following injury. Among these complications is acute respiratory distress, which occurs when the brain is too damaged to regulate breathing. As a result, many patients with severe TBI need emergency intervention to help them breathe until their brains have healed enough to resume control of normal respiratory function. One such intervention is tracheostomy, a procedure in which a doctor cuts a patient’s neck and places a tube into their windpipe, allowing air to enter the lungs.
Although tracheostomies are relatively simple and inexpensive, many clinicians disagree about the best timing of this procedure for patients with TBI. Some argue that tracheostomy should be performed within a few days of injury, while others believe that the procedure is too risky to perform until the patient is stabilized. Researchers are interested to resolve this controversy in pursuit of standard guidance on tracheostomy for severe TBI patients.
A Brazilian research team recently conducted a review of eight high-quality studies that examined severe TBI patients’ outcomes after tracheostomy was performed at various timepoints in the recovery period. The team found that the average time for “early” tracheostomy was 5.59 days after injury, while the average time for “late” tracheostomy was 11.8 days after injury. After analyzing patient outcomes, they determined that:
- Patients who received early tracheostomy spent less time in the intensive care unit (ICU) and the hospital than those who received late tracheostomy.
- Early tracheostomy patients also spent less time receiving support from a mechanical ventilator, a machine that helps patients breathe while their normal respiratory functions recover.
- Because prolonged mechanical ventilation increases patients’ risk of complications (such as infection), late tracheostomy patients were more likely to develop pneumonia as a result of ventilator use.
- There was no significant difference in mortality between early and late tracheostomy patients.
Tracheostomy is a cost-effective, simple procedure that can significantly improve patient outcomes after severe TBI. Compared to patients who undergo this procedure weeks into the recovery period, patients who receive tracheostomy within a week of the initial injury typically require shorter length-of-stay in the hospital, avoid high medical costs associated with mechanical ventilation, and are less likely to develop respiratory infections. Clinicians are advised to consider the benefits of early tracheostomy, a simple procedure that may significantly improve quality of life for people who suffer from severe TBI.
Araujo de Franca S, Tavares WM, Salinet ASM, et al. Early tracheostomy in severe traumatic brain injury patients: A meta-analysis and comparison with late tracheostomy. Critical Care Medicine. (April 2020).