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Indian Journal of Trauma and Emergency Pediatrics 9(3):p 157-160, Jul-Sep 2017. | DOI: http://dx.doi.org/10.21088/ijtep.2348.9987.9317.1
Original Article
Outcome of Early, Before 3rd Day V/S Any Time after 5th Day Elective Tracheostomy in Isolated Head Injury with Diffuse Axonal Injury without Any Surgical Lesion
Amresh S. Bhaganagare, Associate Professor, Bangalore Medical College and Research Institute (BMCRI) Bangalore, 560002. , Amresh S. Bhaganagare* , Prakash Rathod** , Balaji S. Pai*** , Vikas Naik**** , Nagesh S.A.***** , Prakash Rathod**
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Indian Journal of Trauma and Emergency Pediatrics 9(3):p 157-160, Jul-Sep 2017. | DOI: http://dx.doi.org/10.21088/ijtep.2348.9987.9317.1
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Abstract
Patients with isolated severe head injury with diffuse axonal injury and without any surgical lesion poses challenging task, this patient’s need airway control in view of low Glasgow coma scale and possibility of aspiration pneumonia, which increases mortality. One hundred and forty patients with GCS score below 10 werecategorized into four groups. Group A – patients with GCS 7-10 and tracheostomy done within 3 days, Group B- patients with GCS 7-10 and tracheostomy was done after 5 days, Group C- patients with GCS below 6 and tracheostomy done within 3days, and Group D- patients with GCS below 6 and tracheostomy was done after 5 days. The characteristics of these four groups were compared based on the day on which patient was weaned from the ventilator support and connected to T-piece, development of fresh lower respiratory tract infection and death during hospital stay. Results: out of the 140 patients of isolated head injury with diffuse axonal injury without any surgical lesion the average day when patients were weaned from ventilator and connected to T- piece was 4th day in group A, 7th day in group B, 12th day in group C and 19th day in group D. The incidence of lower respiratory tract infectionwas 20% in group A, 31% in group B, 80% in group C and 52.5% in group D. And the mortality while in our hospital was 6.6% in group A, 14% in group B, 40% in group C and 52.5% in group D. Conclusions: Tracheostomy offer advantages in the management of patients of isolated head injury with diffuse axonal injury without any surgical lesion on mechanical ventilation, in this population early tracheostomy can facilitate weaning, safely reducing patient exposure to the risks of MV, and therefore has a positive impact on mortality.
Keywords: Diffuse Axonal Injury; Tracheostomy; Mechanical Ventilation
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DOI: http://dx.doi.org/10.21088/ijtep.2348.9987.9317.1
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