Early Tracheostomy in Adult Patient with Head Trauma: A Case Report
DOI:
https://doi.org/10.12928/admj.v6i1.13239Keywords:
Traumatic Brain Injury , Early Tracheostomy , Mechanical Ventilation , Neurosurgical Intensive Care , Glasgow Coma ScaleAbstract
Traumatic brain injury (TBI) is a serious condition that can cause temporary
or permanent physical, cognitive, and emotional impairments. Tracheostomy
in TBI patients can help reduce airway resistance, improve secretion clearance,
and support weaning from mechanical ventilation. Early tracheostomy (ET)
may also reduce ICU stay, ventilation time, and long-term mortality. A 30-year
old female was referred after a motorbike accident without a helmet. She was
unconscious, with a Glasgow Coma Scale (GCS) of E1V2M1. Vital signs:
temperature 38.1°C, pulse 74/min, respiratory rate 25/min, blood pressure
84/47 mmHg. Eye examination revealed lagophthalmos, chemosis, and a
corneal epithelial defect. Neurological findings included anisocoria (right pupil
5 mm, left 3 mm), with no response in cranial nerves III, IV, and VI. Reflexes
were normal, and no neck stiffness was observed. CT scan showed subdural
hematoma (SDH), subarachnoid hemorrhage (SAH), and intracerebral
hemorrhage (ICH). The patient underwent tracheostomy, central venous
catheter placement, craniotomy, decompression, and hematoma evacuation.
The bleeding volume was 15 cc. She survived and regained consciousness (GCS
compos mentis). This case highlights the potential benefit of early
tracheostomy in severe TBI. While patients with more severe injuries may face
delays due to instability, early intervention can support better outcomes and
survival.
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