ROLE OF EARLY VS LATE TRACHEOSTOMY IN SEVERE TRAUMATIC BRAIN INJURY OUTCOME TO CHECK IN HOSPITAL ICU STAY

Abstract

Background: Traumatic brain injury (TBI) remains a major cause of morbidity and mortality worldwide, often necessitating prolonged ventilatory support and intensive care. Tracheostomy is commonly performed in such patients to facilitate airway management and weaning from mechanical ventilation. However, the optimal timing of tracheostomy—whether early or late—remains a matter of debate. This study aimed to compare the duration of intensive care unit (ICU) stay in patients with severe TBI undergoing early versus late tracheostomy. Methods: This analytical cross-sectional study was conducted in the Department of Neurosurgery, Rawalpindi Teaching Hospital, over six months. A total of 60 patients with severe TBI (Glasgow Coma Scale ≤8) requiring ventilatory support were included through non-probability consecutive sampling and divided equally into early tracheostomy (within 5 days of mechanical ventilation) and late tracheostomy (after 5 days) groups. Data regarding demographic variables, cause and type of injury, complications, and ICU stay were analyzed using SPSS v26. The independent samples t-test and chi-square test were applied, with p < 0.05 considered significant. Results: The mean age of participants was 44.6 ± 13.2 years, and 61.7% were male. Road traffic accidents accounted for most injuries (58.3%). The mean ICU stay was significantly shorter in the early tracheostomy group (7.25 ± 2.30 days) compared to the late group (16.90 ± 3.33 days; p < 0.001). Type of brain injury significantly affected ICU duration (p = 0.008), while baseline GCS showed no correlation with ICU stay (p = 0.143). Conclusion: Early tracheostomy in severe TBI patients significantly reduces ICU stay compared to late tracheostomy. Implementing early tracheostomy protocols may improve patient outcomes and optimize ICU resource utilization, particularly in resource-limited settings like Pakistan.