Quiñones-Ossa Gabriel A, Durango-Espinosa Y A, Padilla-Zambrano H, Ruiz Jenny, Moscote-Salazar Luis Rafael, Galwankar S, Gerber J, Hollandx R, Ghosh Amrita, Pal R, Agrawal Amit
Faculty of Medicine, El Bosque University, Bogota, Colombia.
Cartagena Neurotrauma Research Group Research Line, Faculty of Medicine, University of Cartagena, Cartagena de Indias, Colombia.
J Neurosci Rural Pract. 2020 Apr;11(2):222-229. doi: 10.1055/s-0040-1709971. Epub 2020 May 2.
Tracheostomy is the commonest bedside surgical procedure performed on patients needing mechanical ventilation with traumatic brain injury (TBI). The researchers made an effort to organize a narrative review of the indications, timing, management, complications, and outcomes of tracheostomy in relation to neuronal and brain-injured patients following TBI. The study observations were collated from the published literature, namely original articles, book chapters, case series, randomized studies, systematic reviews, and review articles. Information sorting was restricted to tracheostomy and its association with TBI. Care was taken to review the correlation of tracheostomy with clinical correlates including indications, scheduling, interventions, prognosis, and complications of the patients suffering from mild, moderate and severe TBIs using Glasgow Coma Scale, Glasgow Outcome Scale, intraclass correlation coefficient, and other internationally acclaimed outcome scales. Tracheostomy is needed to overcome airway obstruction, prolonged respiratory failure and as indispensable component of mechanical ventilation due to diverse reasons in intensive care unit. Researchers are divided over early tracheostomy or late tracheostomy from days to weeks. The conventional classic surgical technique of tracheostomy has been superseded by percutaneous techniques by being less invasive with lesser complications, classified into early and late complications that may be life threatening. Additional studies have to be conducted to validate and streamline varied observations to frame evidence-based practice for successful weaning and decannulation. Tracheostomy is a safer option in critically ill TBI patients for which a universally accepted protocol for tracheostomy is needed that can help to optimize indications and outcomes.
气管切开术是对需要机械通气的创伤性脑损伤（TBI）患者实施的最常见的床边外科手术。研究人员致力于对气管切开术在TBI后神经元和脑损伤患者中的适应症、时机、管理、并发症及结果进行叙述性综述。研究观察结果来自已发表的文献，即原创文章、书籍章节、病例系列、随机研究、系统评价和综述文章。信息筛选仅限于气管切开术及其与TBI的关联。在使用格拉斯哥昏迷量表、格拉斯哥预后量表、组内相关系数及其他国际认可的预后量表时，仔细审查了气管切开术与临床相关因素的相关性，包括轻度、中度和重度TBI患者的适应症、安排、干预措施、预后及并发症。在重症监护病房，由于多种原因，需要气管切开术来克服气道阻塞、延长呼吸衰竭时间，并作为机械通气不可或缺的组成部分。研究人员对于气管切开术应在数天至数周内早期进行还是晚期进行存在分歧。传统的经典气管切开术已被经皮技术取代，经皮技术侵入性较小，并发症较少，并发症分为早期和晚期，可能危及生命。必须进行更多研究以验证和简化各种观察结果，从而制定基于证据的实践方法，以实现成功撤机和拔管。对于重症TBI患者，气管切开术是一种更安全的选择，为此需要一个普遍接受的气管切开术方案，以帮助优化适应症和结果。
