Extubation oder Tracheotomie nach schwerem Schädel-Hirn-Trauma

In a prospective manner, the predictive use of clinical and radiological findings for successful extubation and unavoidable tracheotomy after severe traumatic brain injury (TBI) was explored. The course of 120 subjects with unconsciousness for more than 24 hours after traumatic brain injury were analyzed including duration of intubation, rate of unsuccessful extubation, and rate of tracheotomy (before transfer to rehabilitation). The incidence of unsuccessful extubations, as well as the period of intubation correlated significantly with the duration of coma. There was also a negative influence on rate of tracheotomy. We found a correlation of coma depth (24 hours after TBI) and period of intubation. However, this was only constituted when comparing the data with the Bruessel Coma Score. The severity of the brain stem damage, as calculated from the MRI classification of brain injured patients, allowed prediction of the length of intubation, the rate of unsuccessful extubation and of tracheotomy while the patient was still comatose. Nevertheless, a brain stem lesion on MRI was no exclusion criterion for successful extubation. The Injury Severity Score, Glasgow Coma Score, parameters from initial cerebral computer tomography, and from monitoring of intracranial pressure or cerebral perfusion pressure did not correlate. These study results encourage the use of MRI data for prediction in the weaning period after severe TBI.