TRACHEOSTOMY AND PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN THE MANAGEMENT OF THE HEAD-INJURED TRAUMA PATIENT

Forty-three trauma patients underwent tracheostomy (TRACH) and percuta neous endoscopic gastrostomy (PEG) over 21 months. Thirty-one patients had a head injury with Abbreviated Injury Scale greater-than-or-equal -to 3 associated with multi-trauma. This study was undertaken to analy ze demographic and outcome variables with respect to timing of TRACH/P EG in this population. Patients were divided into EARLY (less-than-or- equal-to 7 days) and LATE (>7 days) groups and were analyzed for admis sion Glasgow Coma Scale, Apache II, Injury Severity Score, and [(A-a)D O2] at time of TRACH/PEG. Outcome variables were ICU length of stay (L OS), hospital LOS, days of mechanical ventilation (MV) post-TRACH/PEG, complications, and mortality. Esophagogastroduodenoscopy findings wit h PEG and days to full enteral nutrition were recorded. All demographi c variables were statistically similar between the EARLY and LATE grou ps. The EARLY group had shorter hospital LOS (P < 0.05), total Intensi ve Care Unit LOS (P < 0.05), ICU LOS post-TRACH/PEG (P < 0.05), and fe wer days of MV post-TRACH/PEG (P < 0.05). There were no procedure-rela ted complications of TRACH/PEG in either group. Full Esophagogastroduo denoscopy performed at the time of PEG had a high diagnostic yield in both groups. We conclude that TRACH/PEG performed within the first 7 d ays of injury in the head trauma patient is the procedure of choice fo r long-term airway protection, mechanical ventilation, and enteral nut rition. Combined use of these procedures reduces ICU and hospital LOS and shortens the course of MV.