Early tracheostomy for neurologic critical care patients improves neurologic function and reduces pulmonary infections.

OBJECTIVE

To evaluate the clinical efficacy of early tracheotomy in neurologic critical care patients.

METHODS

A retrospective analysis was conducted on 100 patients with severe craniocerebral injury (SCI) who underwent percutaneous tracheotomy at The First Affiliated Hospital, Zhejiang University School of Medicine from January 2021 to February 2022. Of them, 52 cases (observation group) received the procedure within 24 hours of injury, while 48 patients (control group) received the procedure after 24 hours. Therapeutic efficacy was assessed using the National Institutions of Health Stroke Scale (NIHSS) criteria. The utilization rates of antibiotics, muscle relaxants, and sedatives during hospitalization, along with mechanical ventilation duration, and the length of intensive care were recorded for comparative analyses. Additionally, blood gas indicators, Glasgow Coma Scale (GCS) score, and Disability Rating Scale (DRS) score were compared before and after treatment. Pulmonary infection and case fatality rates were also recorded and compared. The early prognosis of patients was assessed based on their GCS scores during a 3-month postoperative follow-up, and risk factors for adverse prognosis were identified.

RESULTS

The effective rate was evidently higher in the observation group compared to the control group. No statistical inter-group difference was identified in the utilization rate of antibiotics or sedatives during hospitalization (all P>0.05), but the observation group had a lower utilization rate of muscle relaxants than the control group (P<0.05). The observation group showed markedly shorter mechanical ventilation duration and length of intensive care compared with the control group (all P<0.05). Both groups demonstrated significant improvements in blood gas indices, GCS and DRS scores after treatment, with significantly greater improvement in the observation group (all P<0.05). The observation group exhibited lower pulmonary infection and case fatality rates than the control group (all P<0.05). GCS score >3 upon admission, DRS score >15 upon admission, and tracheotomy after 24 h of injury were all independent risk factors for poor early prognosis in patients with SCI.

CONCLUSIONS

Tracheotomy for SCI patients within 24 hours of injury can effectively improve therapeutic efficacy, enhance neurologic function, and reduce the risk of disability and pulmonary infection.