Published: 2018-12-26

Early tracheostomy in patient with severe traumatic brain injury clinical experiences in rural and remote areas

Rohadi M. Rosyidi, Bambang Priyanto, Aulannisa Handayani


Background: Brain injury accounts for most of the causes of death from trauma. Brain injury is defined as a change in brain function, or brain pathology, caused by external forces. Patients with severe brain injury usually required rapid evacuation and special care in the Intensive Care Unit (ICU) room for respiratory control, mechanical ventilation, neurosurgical evaluation, and intracranial pressure monitoring (ICP). During admission to ICU, patients using tracheostomy, because it requires analgesia, sedation, and prolonged ventilation.

Methods: Descriptive retrospective study conducted in February and March 2018 at Medical Record Installation of General Hospital Province of West Nusa Tenggara. The sample size is determined by consecutive sampling method.

Results: Sample size were 60 people from medical record. Male patient more common than female (90 %). Based on Age more patients are 40 years old (43.3%). More Patient with early tracheostomy was survived (68,33%), and the rest died (31,67%).

Conclusions: Severe head injury patients with tracheostomy are common at <18 years and >40 years. Patients with Severe brain injury who get early tracheostomy have more good outcomes, and have relatively short duration of ICU care.


Tracheostomy, Severe traumatic brain injury

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World Health Organization. Global Status Report on Road Safety, WHO Library, 2015. Available at:

Guerrier G, Morisse E, Barguil Y, Gervolino S, Lhote E. Severe traumatic brain injuries from motor vehicle-related events in New Caledonia: Epidemiology, outcome and public health consequences. Aus N Z J Pub Heal. 2015;39(2):188-91.

Health Research and Development Agency, 2013. Basic Health Research Reported. Jakarta, 2013.

Farghaly A, El-Khayat R, Awad W, George S. Head injuries in road traffic accidents. forensic medicine and clinical toxicology, and neurosurgery departments, faculty of medicine, Assiut university, Assiut, Egypt. 2005.

Raj R. Prognostic models in traumatic brain injury. Acta Anaesthesiologica Scandinavica. 2015 May;59(5):679-80.

Marshall SA, Riechers RG. Diagnosis and management of moderate and severe traumatic brain injury sustained in combat. Military medicine. 2012 Aug 1;177(suppl_8):76-85.

Baron DM, Hochrieser H, Metnitz PGH, Mauritz W. Tracheostomy is associated with decreased hospital mortality after moderate or severe isolated traumatic brain injury. Wien KlinWochenschr. 2016;128(11-12):397-403.

Greenberg MS. Head trauma. In: Hiscock T, Landis SE, Casey MJ, Schwartz N, Scheihagen T, Schabert A, editors. Handbook of Neurosurgery. 8th ed. New York: Thieme Medical Publishers; 2016:824-825.

Shibahashi K, Sugiyama K, Houda H, Takasu Y, Hamabe Y, Morita A. The effect of tracheostomy performed within 72 h after traumatic brain injury. Br J Neurosurg. 2017;31(5):564-8.

Grigorakos L, Alexopoulou A, Tzortzopoulou K, Stratouli S, Chroni D, Papadaki E, et al. Predictors of outcome in patients with severe traumatic brain injury. J Neuro Clin Res. 2017 Jun 30;2016.

Rawis M, Lalenoh D, Kumaat L. Profile of patients with moderate and severe head injuries treated in ICU and HCU. e-Clinic J. 2016;4(2).

Simanjuntak F, Ngantung DJ, Mahama CN. Overview of Head Injury Patients in RSUP. E-Clinic. 2015;3(1):353-7.

Jasa ZK, Jamal F, Hidayat I. Outcomes of severe head injury patients performed craniotomy of hematoma evacuation or decompression craniectomy in Dr. Zainoelabidin Banda Aceh. Indo Neuro-anesthesia J. 2014;3(1):8-14.

World Health Organization. Neurological Disorders: public health challenges Geneva: WHO Press; 2006.

Murthy TVSP, Bhatia P, Sandhu K, Prabhakar T, Gogna RL. Secondary brain injury: prevention and intensive care management. IJNT. 2005;2(1):7-12.

Hai-peng F, Yao-jian W, Jian-tao Y, Guo-ping Z, Jian-cong L. Clinical value of ultra-early tracheostomy on emergent treatment of severe traumatic brain injury [J]. Clin J Med Officer. 2007;2:025.

Arabi Y, Haddad S, Shirawi N, Al Shimemeri A. Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Critical care. 2004 Oct;8(5):R347.

Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma Acute Care Surg. 2004 Aug 1;57(2):251-4.

Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM. Early tracheostomy for primary airway management in the surgical critical care setting. Brit J Surg. 1990 Dec;77(12):1406-10.