Intensive Care Medicine

, Volume 26, Issue 8, pp 1101–1107

Early translaryngeal tracheostomy in patients with severe brain damage

Authors

  • N. Stocchetti
    • Department Anesthesia and Intensive Care, Neuroscience Intensive Care, Policlinico Hospital IRCCS, Via Francesco Sforza 35, 20 122 Milan, Italy e-mail: stocchet@polic.cilea.it Tel.: + 39-02-55 03 55 17 Fax: + 39-02-59 90 22 39
  • A. Parma
    • Department Anesthesia and Intensive Care, Neuroscience Intensive Care, Policlinico Hospital IRCCS, Via Francesco Sforza 35, 20 122 Milan, Italy e-mail: stocchet@polic.cilea.it Tel.: + 39-02-55 03 55 17 Fax: + 39-02-59 90 22 39
  • V. Songa
    • Department Anesthesia and Intensive Care, Neuroscience Intensive Care, Policlinico Hospital IRCCS, Via Francesco Sforza 35, 20 122 Milan, Italy e-mail: stocchet@polic.cilea.it Tel.: + 39-02-55 03 55 17 Fax: + 39-02-59 90 22 39
  • A. Colombo
    • Department Anesthesia and Intensive Care, Neuroscience Intensive Care, Policlinico Hospital IRCCS, Via Francesco Sforza 35, 20 122 Milan, Italy e-mail: stocchet@polic.cilea.it Tel.: + 39-02-55 03 55 17 Fax: + 39-02-59 90 22 39
  • M. Lamperti
    • Department Anesthesia and Intensive Care, Neuroscience Intensive Care, Policlinico Hospital IRCCS, Via Francesco Sforza 35, 20 122 Milan, Italy e-mail: stocchet@polic.cilea.it Tel.: + 39-02-55 03 55 17 Fax: + 39-02-59 90 22 39
  • L. Tognini
    • Department of Emergency Surgery, Policlinico Hospital IRCCS, Via Francesco Sforza 35, 20 122 Milan, Italy
ORIGINAL

DOI: 10.1007/s001340051324

Cite this article as:
Stocchetti, N., Parma, A., Songa, V. et al. Intensive Care Med (2000) 26: 1101. doi:10.1007/s001340051324

Abstract

Objectives: To describe the effects of early translaryngeal tracheostomy on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and jugular bulb saturation (SjO2); to identify the main mechanisms affecting ICP during tracheostomy; and to evaluate the long-term effects of tracheostomy on tracheal anatomy and function. Design: Prospective, observational, clinical study. Setting: Neurosurgical intensive care unit in a teaching hospital. Patients: 20 patients admitted to the ICU because of head injury, subarachnoid hemorrhage, or brain tumor with a Glasgow Coma Scale less than 8. Interventions: Patients underwent translaryngeal tracheostomy under strict neuromonitoring. Measurements and results: ICP rose significantly (p < 0.05) at the critical time of cannula placement while all other parameters remained stable. At this time five patients suffered intracranial hypertension (ICP > 20 mmHg). In one of them CPP dropped below 60 mmHg. Arterial CO2 tension (PaCO2) did not rise significantly. No other major complications were recorded during the procedures. Three months after tracheostomy normal findings were detected by tracheoscopy in all cases (11 patients could be examined). Conclusions: Translaryngeal tracheostomy, performed in selected patients when the risk of intracranial hypertension was reduced to the minimum, was well tolerated in the majority of cases and did not induce persistent intracranial disorders. However, ICP is affected by tracheostomy, and careful monitoring and patient selection is necessary. At follow-up no severe anatomical or functional damage was detected.

Key words Brain damageCerebral extraction of oxygenCerebral perfusion pressureIntracranial pressureTracheostomy

Copyright information

© Springer-Verlag Berlin Heidelberg 2000