Weaning From Mechanical Ventilation in Patients With Severe Head Trauma: A Proposol of Tracheostomy Antecipation

Abstract

Background: The aims of the study were to analyze the withdrawal of mechanical ventilation (MV) of severe head trauma from admitted victims to the adult intensive care unit and to propose a time to perform the tracheostomy, not taking into consideration only the Glasgow coma scale (GCS) but the GCS and the Marshall’s computed tomography (CT) scan classification.

Methods: This was a cross-sectional, descriptive, observational study, based on continuous registration database collection, medical and physical therapy records. Data were collected from March 2012 to March 2015.

Results: We collected 118 patients. There was no association between GCS of 3 - 5 and 6 - 8, and Marshall’s CT classification 3 - 4 and 5 - 6, with extubation, reintubation and tracheostomy. Tracheostomy was performed on 50% of the population. Regarding the withdrawal of MV after tracheostomy, 62.71% of patients underwent nebulization protocol ≤ 48 hours. There was no association between GCS of 3 - 5 and 6 - 8, and Marshall’s CT classification 3 - 4 and 5 - 6, with weaning after tracheostomy.

Conclusions: GCS 3 - 5 tends to be less extubated and has reintubation rate higher than GCS of 6 - 8; the worse the rating of Marshall’s CT classification, the lower the extubation rate; and the majority of patients were withdrawn from the ventilator at or less than 48 hours after tracheostomy. We suggest that early tracheostomy, less than 48 hours after intubation, should be performed if clinical and neurological stabilization was achieved in patients with severe traumatic brain injury (TBI) (and Marshall’s CT classification III and IV).




J Neurol Res. 2016;6(2-3):35-40
doi: http://dx.doi.org/10.14740/jnr380w