Clinical research on ea rly tracheotomy combined with hyperventilation in severe traumatic braininjury

doi:10.3969/j.issn.1674-3806.2013.09.06

Abstract：Objective To discuss the clinical value of early tracheotomy combined with hyperventilation in severe traumatic brain injury(sTBI).Methods Eighty patients with sTBI (GCS 3~8) were randomly divided into the observation group and the control group .Within 24 h after admission the observation group′s patients received percutaneous tracheostomy,and in a short time maintained the light to moderate hyperventilation with ventilator .Moni-toring the end-tidal carbon dioxide partial pressure (PetCO2 ),the PetCO2 was maintained at 27~32 mmHg,each time for 30 min,4 times a day,for 7 days.Continuous moderate oxygen supply via face mask was used in control group ′s patients after admission until respiratory failure comes out ,then the percutaneous tracheostomy and mechanical venti-lation(not hyperventilation was performed ).All of the 80 patients received the treatment of preventing infections , re-ducing the intracranial pressure , cerebral protection, nutritional supporting and other symptomatic and supportive therapy.Within 7 days the changes of intracranial pressure (ICP) in the patients were continuously observed and 6 months after injury, the efficacy was evaluated according to GOS valuation method including 5 grades:good, moder-ate disability, severe disability, vegetative state, and death.Results ICP decreased more rapidly in the observation group than the control group, and the difference was statistically significant (P<0.01).After 6 months there were significant differences between the two groups in good , moderate disability, severe disability, vegetative state(P<0.05),without statistically significant difference in mortality rate (P>0.05).Conclusion The early tracheotomy combined with mild to moderate hyperventilation may be beneficial to decreasing ICP , and improving the survival quality for patients within 6 months after sTBI.