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Tracheostomy in craniectomised survivors after traumatic brain injury: A cross-sectional analytical study

机译：颅脑外伤后颅骨切除后幸存者的气管切开术：横断面分析研究

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Background: Decompressive craniectomy (DC) is a life-saving measure for traumatic brain injury (TBI). However, survivors may remain in a vegetative or minimally conscious state and require tracheostomy to facilitate airway management. In this cross-sectional analytical study, we investigated the predictors for tracheostomy requirement and influence of tracheostomy timing on outcomes in craniectomised survivors after TBI. Methods: We enrolled 160 patients undergoing DC and surviving >7 days after TBI in this 3-year retrospective study. The patients were subdivided into 2 groups based on whether tracheostomy was (N = 38) or was not (N = 122) performed. We identified intergroup differences in early clinical parameters. Multivariable logistic regression was used to adjust for independent predictors of the need for tracheostomy. Early tracheostomy was defined as the performance of the procedure within the first 10 days after DC. Intensive care unit (ICU) stay, hospital stay, mortality, and Glasgow outcome scale (GOS) were analysed according to the timing of the tracheostomy procedure. Results: After TBI, 24% of craniectomised survivors required tracheostomy. In the multivariate logistic regression mode, the significant factors related to the need for tracheostomy were age (odds ratio = 1.041; p = 0.002), the Glasgow coma score (GCS) at admission (odds ratio = 0.733; p = 0.005), and normal status of basal cisterns (odds ratio = 0.000; p = 0.008). The ICU stay was shorter for patients with early tracheostomy than for those undergoing late tracheostomy (p = 0.004). The timing of tracheostomy had no influence on the hospital stay, mortality, or GOS. Conclusion: Age and admission GCS were independent predictors of the need for tracheostomy in craniectomised survivors after TBI. If tracheostomy is necessary, an earlier procedure may assist in patient care.
机译：背景：减压颅骨切除术（DC）是挽救脑外伤（TBI）的一种救生措施。但是，幸存者可能仍处于植物状态或意识最弱的状态，需要进行气管切开术以促进气道管理。在这项横断面分析研究中，我们调查了气管切开术需求的预测因素以及气管切开术时机对颅脑切除术后幸存者生存的影响。方法：在这项为期3年的回顾性研究中，我们纳入了160名接受DC且TBI后存活时间超过7天的患者。根据是否进行气管切开术（N = 38）将患者分为2组。我们确定了早期临床参数的组间差异。多变量logistic回归用于调整气管切开术需求的独立预测因素。早期气管切开术的定义是在DC后的前10天内进行该手术。根据气管切开术的时间分析重症监护病房（ICU）的住院时间，住院时间，死亡率和格拉斯哥结局量表（GOS）。结果：TBI后，有24％的颅骨切除幸存者需要进行气管切开术。在多元logistic回归模式中，与需要气管切开术相关的重要因素是年龄（比值比= 1.041; p = 0.002），入院时的格拉斯哥昏迷评分（GCS）（比值比= 0.733; p = 0.005）和基底水箱的正常状态（赔率= 0.000; p = 0.008）。早期气管切开术患者的ICU停留时间比晚期气管切开术患者的ICU停留时间短（p = 0.004）。气管切开的时间对住院时间，死亡率或GOS均无影响。结论：年龄和入院GCS是TBI后开颅切除幸存者进行气管切开术需求的独立预测因素。如果需要进行气管切开术，早期的手术可能会有助于患者的护理。

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