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TRACHEOSTOMY: A LIFE SAVING PROCEDURE IN PATIENTS WITH SEVERE HEAD INJURY

Dr.Zara Javed, Dr Muhammad Abubakar, Dr. Maham Jamil

Background: Tracheostomy is making an opening into anterior wall of trachea. It is a lifesaving procedure when performed in time in patients with severe head injury. It reduces obstruction to airway improves oxygenation by reducing dead space and facilitates toileting thereby contributing a lot in the management protocol of patient who sustain severe head injury. METHODOLOGY: It is prospective observational study 17 cases with severe head injury admitted in Neurosurgery ICU of DHQ Hospital Mirpur AJK who underwent emergency tracheostomy between March 2017 and May 2017. Patients were assessed by Neurosurgeons for the need of tracheostomy and those with Glasgow coma scale (GCS) less than 8 having multiple maxillofacial injuries were included in this study. Patients with GCS more than 11 having no air hunger or facial injury were not included. All operations were performed as emergency procedures after taking informed surgical consent under local anesthesia. Postoperative nursing care was given to the patients and they were followed up. Results :Out of 17 patients, 15(88% ) were male and 2(11.7%) were female with age range from 12 years to 42 years having mean age of 27, 14(82%) cases had Road Traffic Accident, 2 (11.7%) had History of fall and only 1(5.8%) cases had gunshot injury. 15(88%) had got their CT scan done preoperatively whereas remaining 2(11.7%) were scanned after the procedure and initial resuscitation . 14(82.3%) patients showed improvement and did well while 1 patient expired. Average stay in ICU 8 days. Conclusion: Tracheostomy is very useful procedure in severe head injury cases for better ventilation. Tracheostomy is mandatory in road traffic accident patients with severe head injury as in RTA there are also fractures of maxillofacial bones leading compromised air entry.

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