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Severe Head Injury - Considerations in Timing of Tracheostomy

When a loved one has suffered a severe head injury,many tough decisions have to be made family members who may be overwhelmed by what is happening. One of the decisions that frequently is made is if, when and how to protect the patient's airway. In a severe head injury, the patient will typically have a plastic tube inserted through the mouth and into the trachea to breathe for the patient. When the patient has been stabilized, and if the patient does not regain the ability to effectively breath on his or her own, the family is often asked for consent to place a breathing tube through the neck for long-term breathing support. Many times, family members are reluctant to do this. A new May 2010 study, however, shows that patients who had this procedure ["tracheostomy"] earlier had fewer pneumonias than those who had the procedure later. Pneumonia is one of the major complications related to this type of patient.

The study showed the following:

Patients suffering from an acute severe, blunt head injury who underwent tracheostomy more than a week after their hospital admission had nearly twice the risk of developing pneumonia later, compared with those whose tracheostomy was performed during their first week in hospital. According to a study published by critical care surgeon Dr. Nasim Ahmed, "Early tracheostomy reduced the incidence of pneumonia following severe head injury." Patients who did not develop pneumonia had their tracheostomy an average of 9 days after hospital admission, but in patients who developed pneumonia, tracheostomy was performed an average of 11 days following admission. The study showed tracheostomy performed more than 7 days after hospitalization was linked to an 88% increased risk of pneumonia.

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