ニューロリハビリテーションの国際ジャーナル

Timing of Tracheostomy Following Brain Tumour Surgery in Cases Requiring Prolonged Mechanical Ventilation

Abstract

Vikas Chandra Jha*, and Mohammad Shahnawaz Alam

Background: We planned to compare the outcome of early tracheostomy as compared to delayed in patients with brain tumour (supratentorial and infratentorial) requiring prolonged mechanical ventilation (PMV) postoperatively and also tried to search for risk factors responsible for early tracheostomy in view of scarce literature available on it.

Material &Methods: We included 90 cases who underwent tracheostomy for PMV following brain tumour surgery between September 2018 and September 2020. They were divided in group 1 with early tracheostomy comprising 56 and group 2 with 34 patients.

Result: Group 1, had reduced, weaning time from mechanical ventilation (MV) (p=0.031), ICU stay (p<0.023), hospital stay (p<0.029), VAP (p<0.031), short-term mortality (p<0.028) and better Glasgow outcome score (p<0.001) on follow-up compared with Group 2. Increased mass effect with midline shift and ventilator-associated pneumonia (VAP) (p=0.031) were strong predictors of PMV, on stepwise logistic regression analysis and had a Youden’s index of >0.80 and a positive predictive value of 0.88.

Conclusions: Early Patients tracheostomised (<5 days) early for PMV following surgery for brain tumour have better functional recovery and shorter ICU stay. Patients with increased mass effect with increased midline shift and VAP postoperatively have a strong predilection to undergo PMV. However, we should prospectively validate our results in a larger number of cases to substantiate these results.