. The tracheo-team in the management of intracranic pressure during a dilatative tracheostomy in severe head trauma: the impact of a checklist.
Introduction: Percutaneous dilatative tracheostomy (PDT) is a common technique in neurosurgical intensive care. However, it may cause imbalances of brain parameters causing secondary damages.
Aim: To assess the intra cranic pressure (ICP) values and the safety of PDT performed by a tracheo-team of doctors and nurses, according to a procedure described in a checklist, in patients with severe head trauma.
Methods: All patients with severe head trauma, admitted from 2005 to 2015, exposed to PDT and with monitoring, before and after the PDT, of brain parameters (ICP and cerebral perfusion pressure) and mechanical ventilation, were included. The PDT was performed according to a checklist developed by the ward staff.
Results: 1571 patients with severe head trauma were admitted: 721 underwent a PDT, the ICP was monitored in 422. A temporary increase of ICP (>30mmhg) was overall observed in 11.5% of cases among those with baseline ICP >20, >20 and <10mmhg, respectively in 25, 8 and 4% of cases. Major complications were not observed; minor complications were <4%.
Conclusions: Overall and intracranial hypertension complications PDT related are lower than reported in the literature. A checklist for PDT with tracheo-team of nurses and doctors with experience in neuro intensive care allows a safe and reliable management of the procedure in severe head trauma patients.