Fazal Ghani, Muhammad Siddiq, Muhammad Idrees Khan.
Secondary Brain Injury in Early and Late Tracheostomy in Severe Head Injury patients.
Pak J Neuro Surg Jan ;22(2):71-5.

Objective: To determine the risk of secondary brain injury during tracheostomy in severe head injury patients.Material and Methods: The study was carried on 180 patients of severe head injury admitted to Neuro ICU in Lady Reading hospital, Peshawar from March 2015 to March 2017. Early tracheostomy was performed in 95 and late tracheostomy in 85 patients. Patients on ventilator with spontaneous breathing and vitally stable were included and those with no spontaneous breathing, vitally unstable or had already tracheostomy been excluded.Results: From a total of 180 patients, 95 (53%) and 85(47%) patients went under early and late tracheostomy group respectively. In the early group, 35 (37%) patients dropped GCS and 60 (63%) were static or improved. Further, patients who dropped GCS in early group, 32(91%) died while 3 (9%) improved or static. Even patients who improved in early group, 10 (17%) died while 50 (83%) improved or static. While in the late group, 9 (11%) dropped GCS more than 2 points and 76 (89%) were static or improved. Further, patients who dropped GCS in late group, 7 (78%) died while 2 (22%) improved or static. Even patients who improved in late group, 6(8%) died while 70 (92%) improved or static. Overall results of the study show that morbidity and mortality is high among early tracheostomy group than late group.Conclusion: It is concluded that there is risk of secondary brain injury during tracheostomy.

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