EARLY VERSUS LATE TRACHEOTOMY IN SEVERE TRAUMATIC BRAIN INJURY PATIENTS UNDERGOING DECOMPRESSIVE CRANIECTOMY

This study investigates the impact of early versus late tracheotomy on outcomes in severe traumatic brain injury (TBI) patients undergoing decompressive craniectomy. A retrospective review of 60 patients admitted between January 2022 and January 2025 was conducted. Patients were divided into early (tracheotomy days 2 7 post intubation) and late (tracheotomy after day 8) tracheotomy groups. Results showed that early tracheotomy significantly reduced ventilator dependence duration (9.8 vs. 17.4 days, p<0.001), ICU length of stay (15.2 vs. 23.5 days, p<0.001), and total hospital stay (30.3 vs. 44.7 days, p<0.001). Neurological outcomes at 6 months, measured by the Glasgow Outcome Scale (GOS), were more favorable in the early tracheotomy group (p 0.048). There was no significant difference in mortality or tracheostomy related complications between the groups. These findings suggest that early tracheotomy in severe TBI patients undergoing decompressive craniectomy is associated with reduced ventilator dependence, shorter hospital stays, and improved neurological outcomes. Further multicenter randomized controlled trials are warranted to confirm these results.