**6. The benefits of tracheostomy on TBI**

A multidisciplinary team collaborates in patient's care for adequate communication, ventilation and oxygenation [104]. The presence of a TQT may promote greater airway security, assisting in patient's mobilization and engagement to physical therapies [88]. Likewise, TQT allows sedation reduction or cessation, reduction of laryngeal lesions, assist in weaning protocol and improve oral nutrition and communication [105–107]. Mentioned risks are tracheal stenosis, tracheomalacia and hemorrhage [108]. However, TQT benefits overcome procedures risks [94, 109, 110].

Over the past decade, extensive research has been done concerning TQT timing for optimal results in patient's care, and an oscillation of a cut out day to consider TQT as an early procedure (ET) is perceived. Literature reveals authors acceptation of TQT as an early procedure, as those ones performed between 2 and 12 days after admission [111–116].

A systematic review and meta-analysis [115] revealed that ET, in severe TBI patients, is associated with shorter length of mechanical ventilation and intensive care unit (ICU) and hospital stay. Likewise, decreased risk of ventilator associated pneumonia was found. Complementary literature comparing early and late tracheostomy (LT) populations demonstrated lower ICU stay [113, 117–120], lower hospital stay [117, 120], lower rates for pneumonia [113, 117, 119, 120] and lower costs [113, 117].

Healthcare cost management has increasing its role as part of patient's care plan. Given an aging population and rising medical comorbidities, expertise in resource allocation is crucial. Herrit and colleagues [121] demonstrated the average weighted cost of ET (≤4 days) patients in ICU is \$4316 less when compared with

**161**

*Benefits of Early Tracheostomy in TBI Patients DOI: http://dx.doi.org/10.5772/intechopen.93849*

for COVID-19 management [123].

second injury control is concerned.

Paulista de Saude para Alta Complexidade.

The authors declare no conflict of interest.

**Acknowledgements**

**Conflict of interest**

rates than ET.

**7. Conclusion**

LT (≥11 days). A continous demand/imporance of resources was produced and exposed by the latest worldwide heath care crisis caused by Corona Virus 19 (Covid-19). Mattioli et al. [122] briefly exposed that ET (≥7 days <14 days) could promote expedited ICU beds availability. Nonetheless, studies are needed to assure TQT role

Mostly of the presented mortality rates between LT and ET analysis do not demonstrate statistically significance [113, 114, 117, 119, 120, 124–128], which could be a response of ET placement in critical state patients [86]. Hence, no definitive conclusion could be drawn by the absence of mortality significance, as well,

The variation of tracheostomy protocols can contribute to misleading results. A retrospective study [129] across 19 countries and 54 TBI centers in Europe demonstrated that the incidence of ET (≤7 days after admission) ranged from 0 to 17.6% and LT from 7.9 to 32%. A delayed procedure was more likely to happen than an earlier one. LT patients presented higher reintubation, VAP and respiratory failure

Overall, ET could contribute to lower exposure to secondary insults and nosocomial adverse events, rising patient's early rehabilitation and discharge rates, and improve hospital/staff resources management. Establishment of guidelines for further homogenous approaches to better assist severe TBI patients and improve

The authors acknowledge the support of the nonprofit organization Instituto

patients functional state at discharge could not be assured.

*Benefits of Early Tracheostomy in TBI Patients DOI: http://dx.doi.org/10.5772/intechopen.93849*

LT (≥11 days). A continous demand/imporance of resources was produced and exposed by the latest worldwide heath care crisis caused by Corona Virus 19 (Covid-19). Mattioli et al. [122] briefly exposed that ET (≥7 days <14 days) could promote expedited ICU beds availability. Nonetheless, studies are needed to assure TQT role for COVID-19 management [123].

Mostly of the presented mortality rates between LT and ET analysis do not demonstrate statistically significance [113, 114, 117, 119, 120, 124–128], which could be a response of ET placement in critical state patients [86]. Hence, no definitive conclusion could be drawn by the absence of mortality significance, as well, patients functional state at discharge could not be assured.

The variation of tracheostomy protocols can contribute to misleading results. A retrospective study [129] across 19 countries and 54 TBI centers in Europe demonstrated that the incidence of ET (≤7 days after admission) ranged from 0 to 17.6% and LT from 7.9 to 32%. A delayed procedure was more likely to happen than an earlier one. LT patients presented higher reintubation, VAP and respiratory failure rates than ET.
