EARLY TRACHEOSTOMY VS. PROLONGED INTUBATION IN POLYTRAUMA PATIENTS WITH CHEST AND HEAD INJURIES: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: The best time for tracheostomy in polytrauma patients with simultaneous chest and head injuries is a topic of clinical controversy. Longer intubation is also linked to increased ventilator-associated pneumonia (VAP), longer ICU stay, and increased morbidity. The present study compared the advantages of early tracheostomy (within 3–5 days of intubation) over prolonged intubation (≥10 days) in these patients.

Methods: In this prospective randomized controlled trial, 60 mechanically ventilated polytrauma patients with blunt chest trauma and moderate-to-severe traumatic brain injury were randomly assigned to two groups: early tracheostomy (n=30) and prolonged intubation (n=30). Primary outcomes were ICU length of stay and VAP incidence. Secondary outcomes were mechanical ventilation days, sedation days, inflammatory markers, reintubation rate, GCS at ICU discharge, mortality, and total hospital stay.

Results: Early tracheostomy markedly decreased ICU stay (9.4 vs 14.8 days), mechanical ventilation time (7.2 vs 11.5 days), and VAP rate (20% vs 46.7%). It also resulted in decreased CRP levels (38.6 vs 55.4 mg/L), improved oxygenation parameters, more effective secretion removal, and greater GCS at ICU discharge (12.4 vs 10.6). Although mortality rates were not statistically significant, a trend was observed in favor of early tracheostomy. The overall hospital stay was also reduced in the early tracheostomy group (17.2 vs 22.5 days).

Conclusions: Early tracheostomy in chest and head injured polytrauma patients is linked with better respiratory, infectious, and neurological outcomes, such as reduced ICU and hospital durations of stay, less incidence of VAP, and better neurological recovery. These results warrant the implementation of early tracheostomy protocols into trauma care for suitable high-risk patients.