Impact of Early Versus Late Tracheostomy on Neurocritical Care Outcomes in Severe Traumatic Brain Injury: An Observational Study

Abstract

Background: Prolonged mechanical breathing and specialized neurocritical care are frequently necessary for patients with severe traumatic brain injury (TBI). The best time to have a tracheostomy is still debatable, but it helps with ventilator weaning and airway management. While delayed tracheostomy may save needless treatments in patients with early neurological recovery, early tracheostomy may lower ventilator-related problems and ICU stay. Objectives: To evaluate the results of early versus late tracheostomy in NeuroICU patients who have suffered severe traumatic brain injury. Methods: The medical records of severe traumatic brain injury (TBI) patients (GCS ≤8) who needed tracheostomy and mechanical ventilation at Balaji Hospital between January 2023 and December 2025 were examined in this retrospective observational study. Patients were divided into two groups for tracheostomy: early (performed within 7 days) and late (executed beyond 7 days). Student's t-test and Chi-square test were used to analyze demographic information, admission GCS, Rotterdam CT score, ventilator days, length of ICU stay, incidence of ventilator-associated pneumonia (VAP), length of hospital stay, and Glasgow Outcome Scale (GOS) at discharge. A p-value of less than 0.05 was deemed statistically significant. Results: The study had 62 individuals in total, including 31 participants in each group. Compared to the late tracheostomy group, patients having early tracheostomy showed a significantly shorter NeuroICU stay, a shorter duration of mechanical ventilation, and a decreased incidence of ventilator-associated pneumonia. Conclusion: In patients with severe traumatic brain injury, an early tracheostomy may shorten their time on mechanical ventilation, shorten their stay in the NeuroICU, and lower their risk of ventilator-associated pneumonia. For certain severe TBI patients who need long-term ventilatory support, early tracheostomy may be a useful tactic.