Ali Afzal, Muhammad Nadeem Munir, Shoaib Malik, Syed Raza H Rizvi, Lal Rehman.
The impact of early tracheostomy on early weaning off ventilatory support and hospital stay in patients with isolated severe head injury.
Pak J Surg Jan ;32(4):223-8.

Aims /Objective: Th is study was conducted to define the impact of early tracheostomy on early weaning off ventilatory support and hospital stay in patients with isolated severe head injury. Materials and Methods: A prospective clinical study conducted at Jinnah Postgraduate Medical Centre, Karachi over 7 years from August 2008 to July 2015 after obtaining approval from the hospital ethics committee. A total of 76 patients admitted with severe head injury (GCS <8) were enrolled in this study. Results: A total of 76 patients were included in the study out of which 56 were male and 20 were female. Most of the injuries 50/76 (%) were secondary to RTA while the rest were due to fall from height 18/76 or assault 8/76. All patients underwent tracheostomy on 3rd day of admission and weaning off ventilator support was started from 4th day. Out of 76 patients 50 patients were off vent by day 6, 10 by day 8, 7 by day 9 and 9 by day 12. Patients with early weaning off ventilator showed significant improvement in their conscious level with decreased hospital stay. In contrast patients with maximum days to wean developed complications and no significant improvement in conscious level till discharge from hospital. 3 patients died after termination of ventilator support and 2 developed surgical emphysema post tracheostomy. Out of patients with GCS 3-5, 2 died from respiratory complications and 1 from DVT with an overall mortality of 12%. Conclusion: In patients with severe head injury who underwent early tracheostomy at day 3 showed significant improvement in prognosis when compared with other studies. Early tracheostomy in selected patients shows improved prognosis, lesser hospital stay and cost and recommended in patients with severe brain injuries.

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