The role of early tracheostomy in patients with posterior fossa haemorrhage in neurocritical care

Abstract

Studies indicate that early tracheostomy may improve outcomes in critically ill patients, but there is a lack of data specifically relating to patients with posterior fossa haemorrhage. This retrospective study assesses the type and duration of airway management for patients with posterior fossa haemorrhage admitted to a neurocritical care unit (NCCU). Of the 21 patients identified, seven required no airway intervention, eight were managed with endotracheal intubation alone, and six required tracheostomy. Although the median length of airway management for patients with endotracheal intubation alone was two days (n=8), the median delay to tracheostomy was 11 days (n=6). Four patients requiring intubation did not survive their NCCU stay. No patient was successfully extubated later than two days post admission. We recommend early tracheostomy in patients who are not extubatable within a few days of admission but in whom admission characteristics and neurological progress otherwise suggest survival with useful recovery. © The Intensive Care Society 2012.