The Impact of Tracheostomy Timing (Early and Late) on Severe Head Injury Patients Toward Clinical Outcomes


  • Muhammad Farhan Mahmud Clinical Skill Centre, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia.
  • Salizar Mohamed Ludin Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
  • Wan Ling Lee Department of Nursing, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
  • Mohamed Saufi Awang Sultan Haji Ahamad Shah Medical Centre (SASMEC), International Islamic University Malaysia, Pahang, Malaysia.



Tracheostomy, Severe head injury patients, Clinical outcomes


Introduction: Severe head injury patients require a specific treatment plan and nursing care to achieve an optimal clinical outcome. Mild head injury patients may need a few days of hospitalisation for close monitoring and conservative medical administrations. However, in severe head injury cases, the patients may require a more extended period of hospitalisation for a series of complex neuro-medical and neurosurgical management. Tracheostomy may be performed on head injury patients with protracted breathing problems. Early tracheostomy (ET) may improve clinical outcomes  late tracheostomy. ET is defined as the tracheostomy done seven days after the initiation of endotracheal intubation. Objective : The objective of this study is to determine the impact of ET on a patient's clinical outcome before being discharged. Methodology: This is a retrospective cohort study involving 45 severe head injury patients with tracheostomy done in two Neuro-Centre hospitals in Klang Valley. The clinical outcome was observed before the participants are discharged including the participant's GCS upon discharge, length of stay (LOS) in the ICU and hospital, the incidence of VAP, duration of mechanical ventilation dependency, and decannulation rate. Findings: There are 45 participants in this study as the sample. Crude analysis performed in this study showed that there is a significant association between tracheostomy classification (early and late) toward participant length of stay in the ICU with a p-value of <0.001, LOS in the hospital (p=0.002), and duration on the mechanical ventilation use (p<0.001) with no association with the GCS upon discharge (p=0.057), the incidence of VAP (p=0.374), and decannulation rate (p=0.081).Potential confounding factors in this study were determined statistically. It was done by comparing the model without an additional factor and the model with an additional factor. Multivariate analysis showed that the association between these variables remained significant for the LOS in the hospital (p=0.035) and duration of mechanical ventilation used (p=0.005). Conclusion: The initiation of ET contributes to a favourable clinical outcome in terms of the duration of mechanical ventilation and length of hospital stay for patients with a severe head injury. However, the association between tracheostomy categorisation and ICU LOS, incidence of pneumonia, decannulation rate, and GCS at discharge was not statistically significant.


Maconochie I, Ross M. Head Injury?: Moderate to Severe. BMJ Publishing Groups; 2010.

Ling TL, Har LC, Nor MRM, Ismail NI, Ismail WNW. Malaysian Registry of Intensive Care 2017 Report. 64; 2017.

Liew BS, Andre D, Cecilia A, Clement ET, Gee TS, Jalil I, et al. Early Management of Head Injury in Adults. In Malaysia Health Technology Assessment Section (MaHTAS); 2015.

Asehnoune K, Roquilly A, Cinotti R. Respiratory Management in Patients with Severe Brain Injury. Critical Care, 22(1), 1–6;2018.

Fukuda S, Warner DS. Cerebral protection. British Journal of Anaesthesia, 99(1), 10–17;2007.

Franco-Jimenez JA, Ceja-Espinosa A, Alvarez-Vazquez L, Vaca-Ruiz MA. (pp. 200–206). Academia de Cirugia; 2002.

Shibahashi K, Sugiyama K, Houda H, Takasu Y. The effect of tracheostomy performed within 72 h after traumatic brain injury. British Journal of Neurosurgery, 2(1) ;2017.

Siddiqui U T, Tahir M Z, Shamim M S, Enam SA. Clinical outcome and cost effectiveness of early tracheostomy in isolated severe head injury patients; 2015.

Pelosi P, Ferguson ND, Frutos-Vivar F. Management and outcome of mechanically ventilated neurologic patients. Crit Care Med. 39:1482–1492;2011. doi10.1097/CCM.0b013e31821209a8.

Robba C, Galimberti S, Graziano F, Wiegers EJA, Lingsma HF, Iaquaniello C, et al. Tracheostomy practice and timing in traumatic brain ? injured patients?: a CENTER ? TBI study; 2020.

Tai HP, Lee DL, Chen CF, Huang YCT. The effect of tracheostomy delay time on outcome of patients with prolonged mechanical ventilation: A STROBE-compliant retrospective cohort study. Medicine, 98(35), e16939;2019.

Catalino MP, Lin F, Davis N, Anderson, K, Olm-shipman C,Jordan JD. Early versus late tracheostomy after decompressive craniectomy for stroke. 1–9; 2018.

Dochi H, Nojima M, Matsumura M. Effect of Early Tracheostomy in Mechanically Ventilated Patients. June, 292–299;2019.

Kim TH, Kim HS, Yang SH, Kim IS, Hong JT, Sung JH, Son BC, Lee SW. Early and Late Tracheostomy after Decompressive Craniectomy for Severe Traumatic Brain Injury. Journal of Korean Neurotraumatology Society, 5(2), 89;2009.

Qureshi MSS, Shad ZS, Shoaib F, Munawar K, Saeed ML, Hussain SW, et al. Early Versus Late Tracheostomy After Decompressive Craniectomy. Cureus, 10(12); 2018

Pinheiro dV, Tostes R, Brum CI, Carvalhoi EV, Pinto SPS, Oliveira JCA. Early Vs Late Debate; 2010.

Wang HK, Lu K, Liliang PC, Wang KW, Chen HJ, Chen TB, Liang CL. The impact of tracheostomy timing in patients with severe head injury: An observational cohort study. Injury, 43(9), 1432–1436;2012.

Alali AS, Scales DC, Fowler RA, Mainprize TG, Ray JG, Kiss A, De Mestral C, Nathens AB. Tracheostomy timing in traumatic brain injury: A propensity-matched cohort study. Journal of Trauma and Acute Care Surgery, 76(1), 70–78;2014.

Huang YH, Lee TC, Liao CC, Deng YH, Kwan AL. Tracheostomy in craniectomised survivors after traumatic brain injury: A cross-sectional analytical study. Injury, 44(9), 1226–1231;2013.

Jeon Y, Hwang J, Lim Y, Lee SY, Woo KI, Park HP. Effect of Tracheostomy Timing on Clinical Outcome in Neurosurgical Patients: Early Versus Late Tracheostomy. Neurosurg Anesthesiol, 26(1), 22–26;2014.

Gessler F, Mutlak H, Lamb S, Hartwich M, Adelmann M, Platz J, et al. The Impact of Tracheostomy Timing on Clinical Outcome and Adverse Events in Poor-Grade Subarachnoid Hemorrhage*. 3–5;2015.

Khalili H, Ghaffarpasand F, Niakan A, Golestani N, Ahrari I, Abbasi HR, et al. Determinants of reoperation after decompressive craniectomy in patients with traumatic brain injury: A comparative study. Clinical Neurology and Neurosurgery, 181, 1–6;2019.

Alsherbini K, Goyal N, Metter EJ, Pandhi A, Tsivgoulis G, Huffstatler T, et al. Predictors for Tracheostomy with External Validation of the Stroke ? Related Early Tracheostomy Score ( SETscore ). Neurocritical Care, 30(1), 185–192;2019.

Rizk EB, Patel AS, Stetter CM, Chinchilli VM, Cockroft KM. Impact of Tracheostomy Timing on Outcome After Severe Head Injury. 481–489;2011.

Marra A, Vargas M, Buonanno P, Iacovazzo C, Coviello A, Servillo G. Early vs. Late Tracheostomy in Patients with Traumatic Brain Injury: Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 10(15), 3319;2021. doi:10.3390/jcm10153319

Baron DM, Hochrieser H, Metnitz PG, Mauritz W. Tracheostomy is associated with decreased hospital mortality after moderate or severe isolated traumatic brain injury. Wiener klinische Wochenschrift, 128(11-12), 397–403;2016.

McLaughlin C, Darcy D, Park C, Lane CJ, Mack WJ, Bliss DW, et al. Timing of tracheostomy placement among children with severe traumatic brain injury: A propensity-matched analysis. Journal of Trauma and Acute Care Surgery, 87(4), 818–826; 2019.

Schneider H , Hertel F, Kuhn M, et al. Decannulation and Functional Outcome After Tracheostomy in Patients with Severe Stroke (DECAST): A Prospective Observational Study. Neurocrit Care 27, 26–34; 2017.




How to Cite

Mahmud, M. F., Ludin, S. M., Lee, W. L., & Awang, M. S. (2023). The Impact of Tracheostomy Timing (Early and Late) on Severe Head Injury Patients Toward Clinical Outcomes. INTERNATIONAL JOURNAL OF CARE SCHOLARS, 6(2), 15–25.

Most read articles by the same author(s)

1 2 > >>