经皮扩张气管切开时机对老年重度颅脑损伤预后的影响

目的比较不同时机经皮扩张气管切开术（PCT）对老年重度颅脑损伤患者预后的影响。方法回顾性分析127例行PCT的老年重度颅脑损伤患者,根据气管切开时间分为早期（A组≤5d,n=58）、晚期（B组〉5d,n=69）2组,记录2组患者一般情况、气管切开当天GCS昏迷评分、ICU留滞时间、在院病死率、90d病死率、1a病死率等,同时记录2组患者肺部感染情况、呼吸机支持天数等。结果 A组患者的90d病死率及1a病死率较B组无明显变化（P〉0.05）,但A组肺部感染发生率、ICU留滞时间、呼吸机支持天数及在院病死率明显低于B组（P〈0.05）。结论对于老年重度颅脑损伤患者,早期经皮扩张气管切开可能并不能明显改善其长期预后,但可显著缩短呼吸机支持时间和ICU住院时间,降低肺部感染发生率及在院病死率。     

院前骨髓腔输液及院内经皮气管切开术在重型颅脑损伤患者中应用

目的 探讨院前骨髓腔穿刺输液及院内经皮气管切开术在重型颅脑损伤患者中治疗效果。方法 选取郑州大学第二附属医院收治的76例重型颅脑损伤患者,其中院前骨髓腔穿刺输液及院内经皮气管切开术治疗组38例,院前骨髓腔穿刺输液及院内气管插管术治疗组38例,分析比较2组患者的肺部感染率、呼吸机使用时间、带管时间、EICU住院时间、抗生素使用时间、感染控制时间、病死率。结果 院前骨髓腔穿刺输液及院内经皮气管切开术治疗组患者的肺部感染率、呼吸机使用时间、带管时间、EICU住院时间、抗生素使用时间、感染控制时间均少于院前骨髓腔穿刺输液及院内气管插管术治疗组,差异有统计学意义(P0.05);2组患者病死率比较,差异无统计学意义(P0.05)。结论 院前骨髓腔穿刺输液及院内经皮气管切开术在重型颅脑损伤患者治疗中效果较好,值得推广和应用。     

序贯性建立人工气道在重症脑损伤患者救治中的应用

目的探讨序贯性建立人工气道对重症脑损伤患者救治中的安全性的影响。方法选取2010-04-2014-03入住重症医学科(ICU)时APACHE-Ⅱ评分≥15分、4分≤GCS≤8分、ICU住院时间≥3d、估计气管插管超过3~7d者的重症脑损伤患者44例,随机分为2组,分别按不同方法实施气道开放,试验组采用序贯气道开放法,即在气管切开导管置入气管内之前仍保留气管插管,待气切导管完全正确放置,再拔除气管插管,全过程始终使用呼吸机辅助通气,常规组在气管切开造口过程中不使用呼吸机辅助通气,仅吸氧4~8L/min;观察2组患者的操作时间、APACHE-Ⅱ评分、生命体征、术后24h NSE水平、血气分析以及随访3个月的GOS评分。结果 (1)2组患者入科时、气管切开术前APACHE-Ⅱ、HR、RR、Bp、SpO2比较差异无统计学意义(P0.05);气管切开造口术后与入科时APACHE-Ⅱ、SpO2相比差异均有统计学意义(P0.05);同时气管切开术后APACHE-Ⅱ、HR、RR、Bp、SpO2在2组患者间的差异均有统计学意义(P0.05)。(2)2组患者入科时以及气管切开前血气分析中的pH、PaO2、PaCO2和术后NSE水平差异均无统计学意义(P0.05);气管切开造口术后与入科时相比升高,差异有统计学意义(P0.05);对比2组患者的气管切开术后pH、PaO2、PaCO2和术后NSE水平差异具有统计学意义(P0.05)。(3)2组患者3个月后生存质量相比差异有统计学意义(P0.05)。结论重症脑损伤患者因长期呼吸机辅助通气,采取序贯性人工气道开放法能确保其安全性,改善预后,提高抢救成功率。     

神经外科术后气管切开术的并发症与手术时机的选择

目的 探讨神经外科术后气管切开术并发症发生率及气管切开时机的选择。方法 回顾性分析2012年8月至2013年8月收治的266例神经外科术后建立人工气道的临床资料。结果 266例中,单纯气管插管209例（18例出院随访数据缺失）,其中气管插管时间<7 d 148例,7~14 d 24例,>14 d 19例;行气管切开术57例[3例出院随访数据缺失,余54例中,早期气管切开术（气管插管时间≤7 d）38例,晚期气管切开术（气管插管时间>7 d）16例]。单纯气管插管病人肺部感染发生率及院内病死率均明显低于气管切开术病人（P<0.05）,入住ICU时间较气管切开术病人明显缩短（P<0.05）。住院期间,早期与晚期气管切开术病人肺部感染发生率、机械通气时间、入住ICU时间、GCS评分均无统计学差异（P>0.05）;出院后,早期与晚期气管切开术病人严重出血、皮下气肿、气胸、肺部感染、气管狭窄等发生率以及病死率均无统计学差异（P>0.05）。结论 神经外科术后病人是否需要早期气管切开术或晚期气管切开术,需要综合考虑病人情况及利弊得失,做出对病人最有利的决策。     

延髓肿瘤开颅手术患者围手术期呼吸功能的管理分析

目的延髓肿瘤围手术期呼吸功能的麻醉管理。方法回顾性分析北京天坛医院神经外科延髓肿瘤手术患者的病例资料,重点分析此类患者的麻醉期间和围手术期呼吸功能管理。结果 2014年1月至10月有28例延髓肿瘤患者入组,病理性质以胶质瘤为主;术前吞咽功能障碍及呼吸功能异常比率分别为46.4%(13/28)和3.6%(1/28),术中经鼻插管比率为42.8%(12/28);有75%(21/28)患者采取术后保留气管导管观察,出现呼吸功能障碍需要进行气管切开、呼吸机辅助通气分别为31.4%(9/28)和35.7%(10/28)。恶性肿瘤患者术后呼吸功能异常率较良性肿瘤高。结论延髓恶性肿瘤术后常出现呼吸功能障碍,术后保留气管导管,尤其是经鼻气管插管,有助于术后呼吸功能管理,必要时进行气管切开术及呼吸机辅助通气。     

ICU脑出血患者肺部感染的影响因素分析

目的探讨影响ICU脑出血患者肺部感染的因素。方法选择我院ICU 2015-07-2016-07收治的脑出血患者111例为研究对象,回顾性分析其治疗过程和临床资料,运用Logistic回归分析对脑出血患者肺部感染的危险因素进行多因素分析。结果通过气管切开方式开放气道或气管插管及使用呼吸机时间≥3d的患者出现肺部感染的风险明显上升(P0.05);合并昏迷及慢性阻塞性肺疾病、住院时间≥14d、既往吸烟史且年龄≥60岁患者发生肺部感染的比率上升(P0.05);Logistic多因素分析发现,肺部感染与气管切开或气管插管、运用呼吸机时间≥3d、昏迷、合并慢性阻塞性肺疾病、住院时间≥14d、有吸烟史及年龄≥60岁等因素有关。结论 ICU脑出血患者出现肺部感染的影响因素有很多,应该加强病情监测,采取有效措施预防肺部感染,降低病死率。     

重症脑血管病患者气管切开选择时机的探讨

目的探讨需机械通气的重症脑血管病患者的合适气管切开时机。方法回顾性纳入2009年1月至2014年12月天津市海河医院神经外科重症监护病房（NICU）和天津医科大学总医院NICU行气管切开的153例重症脑血管病患者,按照入住NICU至气管切开时间分为早期切开组（〈4d,简称早切组,共80例）和晚期切开组（7—14d,简称晚切组,共73例）。对比两组的NICU住院时长,总住院时长,镇静药、呼吸机以及抗生素使用时长,肺炎发生率,病死率,神经功能改善情况,气管切开相关并发症以及拔管时间。结果早切组在平均NICU住院时长、平均总住院时长、平均镇静药使用时长、平均呼吸机使用时长、平均抗生素使用时长方面优于晚切组（均P〈0．01）。早切组较晚切组肺炎发生率低（P〈0．01）。在气管切开并发症发生情况、NICU病死率、住院总病死率、出院时改良Rankin量表评分（mRS）方面,两组差异均无统计学意义（均P〉0．05）。随访时间为6个月。早切组获随访70例,晚切组获随访64例。获随访的早切组患者的拔管时间早于晚切组患者（P=0．03）。结论对于需较长时间机械通气的重症脑血管病患者,与晚期气管切开相比,早期实施气管切开可减少N1CU住院时长,总住院时长,镇静药、呼吸机以及抗生素使用时长,且肺炎发生率更低,拔管时间较早;但对住院期间病死率和神经功能方面无明显改善。     

气管切开时机对大量高血压脑出血外科治疗患者生存状况的影响

目的研究气管切开时机对大量高血压脑出血外科治疗患者生存状况的影响。方法回顾2011-04—2015-04我院收治的大量高血压脑出血患者80例,按照气管切开的时机分为早期气管切开组35例,晚期气管切开组45例。对于早期气管切开组患者,急诊手术同时行气管切开。患者进入手术室行术前准备后,由手术医师快速行经皮微创气管切开术(PDT)。晚期气管切开组根据病情于术后2~14d内行气管切开术,操作同上。结果 35例早期气管切开组患者好转32例(91.4%),死亡3例(8.6%);45例晚期气管切开组好转出院35例(77.8%),死亡10例(22.2%);早期气管切开组肺部感染23例(65.7%),晚期气管切开组肺部感染45例(100%)。早期气管切开组肺部感染率明显低于晚期气管切开组,差异有统计学意义(P0.05);早期气管切开组术后2个月日常生活能力(ADL)Ⅱ~Ⅲ级25例(71.4%),ADLⅣ级7例(20%)。晚期组术后2个月ADLⅡ~Ⅲ级20例(44.4%),ADLⅣ级15例(33.3%)。术后2个月后早期组日常生活能力明显高于晚期组;早期气管切开组平均住院时间(34.13±6.51)d,晚期气管切开组为(43.45±10.72)d,早期组平均住院时间少于晚期组,早期组再出血2例(5.71%),晚期组再出血5例(11.11%),差异有统计学意义(P0.05)。结论早期气管切开可有效提高患者的好转出院率,减轻肺部感染,提高日常生活能力,且可以缩短住院时间,降低再出血风险。     

重型颅脑损伤并发医院获得性肺炎的相关因素分析

目的 探讨重型颅脑损伤（TBI）患者治疗期间医院获得性肺炎（HAP）的发生率及其相关影响因素.方法 回顾性分析首都医科大学附属北京天坛医院神经外科2016年3月至2017年3月收治的114例重型TBI患者的临床资料.治疗过程中37例患者行气管插管,其中24例在插管后行气管切开术;4例直接行气管切开术.根据气管切开时间,将患者分为早切开组（损伤时间≤7 d,18例）和晚切开组（损伤时间〉7d,10例）.所有患者出院时行格拉斯哥预后评级（GOS）.统计治疗期间HAP的发生率,分析影响重型TBI患者发生HAP的危险因素,进一步分析气管早切开与晚切开对患者疗效的影响.结果 114例患者中,23.7％（27/114）诊断为HAP.经治疗后73.7％（84/114）的患者预后较好（GOSⅢ-Ⅴ级）,26.3％（30/114）预后不良（GOS Ⅰ-Ⅱ级）.多因素分析结果显示,既往合并肺部疾病、气管插管或气管切开、伴有颅内感染及弥漫性轴索损伤是发生HAP的独立危险因素（均P 〈0.05）.伤后行气管早切开组的患者在颅骨骨折比例、住院时间及治疗费用方面显著优于晚切开组（均P〈0.05）.结论 既往合并肺部疾病、气道方面操作、颅内感染及弥漫性轴索损伤可增加重型TBI患者HAP的发生率,且损伤后7d内行气管切开术,可减少患者的颅骨骨折比例、住院时间和治疗费用.     

鼻插管及肺泡灌洗救治重型颅脑伤的临床意义

目的探讨鼻插管及纤支镜下肺泡灌洗救治重型颅脑伤呼吸障碍患者替代气管切开的可行性及临床意义。方法比较分析43例经鼻气管插管与55例气管切开的重型颅脑伤患者氧代谢情况、肺部并发症发生率情况,人工气道放置、住院日期长短及预后情况。结果经鼻气管插管与气管切开均能够满足呼吸障碍患者的基本氧代谢或施行机械通气的需要,二者问无明显差异P>0.05;经鼻插管组肺部感染及双重感染的并发症低于气管切开组.P<0.01,尤其在GCS≥6分患者中其差异更具显著性P<0.01,住院时间短.预后优于气管切开组P<0.01。结论对重型颅脑损伤合并呼吸障碍特别是GCS≤6～8分的患者可先考虑经鼻气管插管取代气管切开。     

The Effectiveness of Early Tracheostomy (within at least 10 Days) in Cervical Spinal Cord Injury Patients

Objective

This study aimed to determine the optimal time for tracheostomy by evaluating the benefits and safety of early versus late tracheostomy in spinal cord injury (SCI) patients.

Methods

We retrospectively reviewed a total of 254 patients with spinal cord injury. Of them, we selected 21 spinal cord injury patients who required tracheostomy due to long-term mechanical ventilation and analyzed their medical records. The patients were categorized into two groups. Early tracheostomy was performed day 1-10 from intubation in 10 patients and the late tracheostomy was performed after day 10 in 11 cases. We also evaluated the duration of mechanical ventilation, stay in the ICU and complications related to tracheostomy, the injury level of and clinical severity. All data was analyzed using SPSS 18.0/WIN.

Results

The early tracheostomy offered clear advantages for shortening the total ICU stay (20.8 day vs. 38.0 day, p=0.010). There was also statistically significant reduction in the total length of time on mechanical ventilation (5.2 day vs. 29.2 day, p=0.009). However, the reductions in the incidence of pneumonia (40% vs. 82%) and the length of ICU stay post to tracheostomy (6 day vs. 15 day) were found to be statistically not significant. There were also no statistically significant differences in the injury level and clinical severity between the groups.

Conclusion

We concluded that the early tracheostomy (at least 10 days) is beneficial for SCI patients who are likely to require prolonged mechanical ventilation.     

重症脑血管病患者早期气管切开的临床价值

目的 &#8197;探讨重症脑血管病患者早期气管切开的临床价值。方法 回顾性分析102例重症脑血管病患者。所有患者入院48&#8197;h内进行了气管插管，气管插管后5&#8197;d内进行了气管切开者55例（早期气管切开组）；气管插管5&#8197;d后进行了气管切开者47例（延迟气管切开组）。比较两组间病死率、镇静药物的用量、院内获得性肺炎（HAP）的发生率、机械通气的时间、ICU住院时间等指标。结果 早期气管切开组机械通气的时间、ICU住院时间、抗生素使用天数和镇静剂的用量均低于延迟气管切开组，差异有统计学意义[（177±94）h&#8197;vs（266±162）h，P=0.03；（10±5）d&#8197;vs（13±4）d，P=0.006；（9±4）d&#8197;vs（12±4）d，P=0.03；（139±39）mg&#8197;vs（186±48）mg，P=0.001）]。两组病死率和HAP的发生率差异无统计学意义（29.1%&#8197;vs&#8197;36.2%，P=0.45；49.1%&#8197;vs&#8197;63.8%，P=0.13）。结论 重症脑血管病患者早期气管切开可获得较大的收益，提倡早期气管切开以改善预后。     

Effect of Early Versus Late Tracheostomy or Prolonged Intubation in Critically Ill Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis

Background

The optimal timing of tracheostomy placement in acutely brain-injured patients, who generally require endotracheal intubation for airway protection rather than respiratory failure, remains uncertain. We systematically reviewed trials comparing early tracheostomy to late tracheostomy or prolonged intubation in these patients.

Methods

We searched 5 databases (from inception to April 2015) to identify randomized controlled trials comparing early tracheostomy (≤10 days of intubation) with late tracheostomy (>10 days) or prolonged intubation in acutely brain-injured patients. We contacted the principal authors of included trials to obtain subgroup data. Two reviewers extracted data and assessed risk of bias. Outcomes included long-term mortality (primary), short-term mortality, duration of mechanical ventilation, complications, and liberation from ventilation without a tracheostomy. Meta-analyses used random-effects models.

Results

Ten trials (503 patients) met selection criteria; overall study quality was moderate to good. Early tracheostomy reduced long-term mortality (risk ratio [RR] 0.57. 95 % confidence interval (CI), 0.36–0.90; p = 0.02; n = 135), although in a sensitivity analysis excluding one trial, with an unclear risk of bias, the significant finding was attenuated (RR 0.61, 95 % CI, 0.32–1.16; p = 0.13; n = 95). Early tracheostomy reduced duration of mechanical ventilation (mean difference [MD] ?2.72 days, 95 % CI, ?1.29 to ?4.15; p = 0.0002; n = 412) and ICU length of stay (MD ?2.55 days, 95 % CI, ?0.50 to ?4.59; p = 0.01; n = 326). However, early tracheostomy did not reduce short-term mortality (RR 1.25; 95 % CI, 0.68–2.30; p = 0.47 n = 301) and increased the probability of ever receiving a tracheostomy (RR 1.58, 95 % CI, 1.24–2.02; 0 < 0.001; n = 377).

Conclusions

Performing an early tracheostomy in acutely brain-injured patients may reduce long-term mortality, duration of mechanical ventilation, and ICU length of stay. However, waiting longer leads to fewer tracheostomy procedures and similar short-term mortality. Future research to explore the optimal timing of tracheostomy in this patient population should focus on patient-centered outcomes including patient comfort, functional outcomes, and long-term mortality.

     

重症卒中患者早期不同气道开放方式对肺部感染及气管插管的影响

目的 研究重症卒中患者早期应用口咽通气管或鼻咽通气管的临床应用效果。方法 连续纳入2020年6月—2022年6月首都医科大学附属北京天坛医院急诊抢救室收治的重症卒中患者,根据患者留置口咽通气管、鼻咽通气管、未留置口/鼻咽通气管分为口咽通气管组、鼻咽通气管组、对照组,对其临床资料进行回顾性分析。比较各组间临床特征、入院7 d内肺部感染发生情况、序贯气管插管转化率及转化时间。结果 共纳入213例重症卒中患者,男性123例,脑出血119例,脑梗死94例。鼻咽通气管组79例,口咽通气管组68例,对照组66例。鼻咽通气管组入院7 d内误吸发生率低于对照组（10.13%vs. 19.70%,P=0.034）及口咽通气管组（10.13%vs. 22.06%,P=0.021）。鼻咽通气管组入院7 d内肺部感染发生率低于对照组（32.91%vs. 59.09%,P=0.018）与口咽通气管组（32.91%vs. 45.59%,P=0.023）。鼻咽通气管组、口咽通气管组、对照组三组7 d院内全因死亡率（30.38%vs. 32.35%vs. 34.84%,P=0.660）整体差异无统计学意义。鼻咽通气管...     

Influence of Single-Dose Antibiotic Prophylaxis for Early-Onset Pneumonia in High-Risk Intubated Patients

Background

Early-onset pneumonia (EOP) after endotracheal intubation is common among critically ill patients with a neurologic injury and is associated with worse clinical outcomes.

Methods

This retrospective cohort study observed outcomes pre- and post-implementation of an EOP prophylaxis protocol which involved the administration of a single dose of ceftriaxone 2 g around the time of intubation. The study included patients ≥ 18 years who were admitted to the University of North Carolina Medical Center (UNCMC) neuroscience intensive care unit (NSICU) between April 1, 2014, and October 26, 2016, and intubated for ≥ 72 h.

Results

Among the 172 patients included, use of an EOP prophylaxis protocol resulted in a significant reduction in the rate of microbiologically confirmed EOP compared to those without prophylaxis (7.4 vs 19.8%, p = 0.026). However, EOP prophylaxis did not decrease the combined incidence of microbiologically confirmed or clinically suspected EOP (32.2 vs 37.4%, p = 0.523). No difference in the rate of late-onset pneumonia (34.6 vs 26.4%, p = 0.25) or virulent organism growth (19.8 vs 14.3%, p = 0.416) was observed. No difference was observed in the duration of intubation, duration of intensive care unit (ICU) stay, duration of hospitalization, or ICU antibiotic days within 30 days of intubation. In hospital mortality was found to be higher in those who received EOP prophylaxis compared to those who did not receive prophylaxis (45.7 vs 29.7%, p = 0.04).

Conclusions

The administration of a single antibiotic dose following intubation may reduce the incidence of microbiologically confirmed EOP in patients with neurologic injury who are intubated ≥ 72 h. A prophylaxis strategy does not appear to increase the rate of virulent organism growth or the rate of late-onset pneumonia. However, this practice is not associated with a decrease in days of antibiotic use in the ICU or any clinical outcomes benefit.

     

Guillain-Barré syndrome: management of respiratory failure

Nineteen of 38 consecutive patients with Guillain-Barré syndrome were treated with mechanical ventilation in a neurological ICU. A ventilator was used for expiratory vital capacity (VC) below 12 to 15 ml/kg or arterial PO2 below 70 mm Hg, or clinical signs of fatigue. Artificial ventilation was discontinued when VC reached 8 to 10 ml/kg. Twelve patients required tracheostomy at 11 days (mean) after intubation. Mechanical ventilation was required for 49 days (mean). Complications included pneumonia in 15 patients, mostly aspiration, only 1 severe; pulmonary embolus in 1 ventilated and 1 nonventilated patient; and tracheal stenosis in 1. There was one death in a previously unintubated patient who developed sepsis while improving from GBS, and no deaths in the 18 other intubated patients.     

Outcome of survivors of acute stroke who require prolonged ventilatory assistance and tracheostomy

BACKGROUND AND PURPOSE: Mechanical ventilation after stroke is associated with high mortality. However, little is known about survivors who require prolonged ventilatory assistance and tracheostomy. Our goal was to assess the rate of pulmonary complication, effect of early tracheostomy and prognosis of patients with stroke requiring prolonged ventilatory support. METHODS: Retrospective review of 97 patients with stroke who required ventilatory assistance and tracheostomy admitted to a single teaching hospital between 1976 and 2000. Outcome was defined using the Glasgow Outcome Scale (GOS). RESULTS: Poor outcome (GOS 1-3) occurred in 74% of patients at 1 year and it was associated with older age (p = 0.03), prior history of brain damage (p = 0.02), and neurological worsening after intubation (p < 0.01). However, long-term functional recovery (GOS 4-5) was possible and more likely after strokes involving the posterior circulation (p = 0.03). Pulmonary complications were prevalent and more frequent before tracheostomy (68 vs. 20% after tracheostomy) but did not determine functional outcome. Mean duration of mechanical ventilation was 11 +/- 19 days and did not significantly differ between outcome groups. Early tracheostomy correlated with shorter ICU and hospital stays (p < 0.01 in both cases). CONCLUSIONS: Surviving patients with stroke who require prolonged ventilatory assistance and tracheostomy can have a better outcome than previously reported. Aggressive care is justified in patients who do not continue to deteriorate neurologically. Pulmonary complications are frequent but treatable. Early tracheostomy can shorten ICU and hospital stays and reduce costs.     

The morbidity of Guillain-Barré syndrome admitted to the intensive care unit

Patients with severe forms of Guillain-Barré syndrome (GBS) require intensive care. Specific treatment, catheterization, and devices may increase morbidity in the intensive care unit (ICU). To understand the spectrum of morbidity associated with ICU care, the authors studied 114 patients with GBS. Major morbidity occurred in 60% of patients. Complications were uncommon if ICU stay was less than 3 weeks. Respiratory complications such as pneumonia and tracheobronchitis occurred in half of the patients and were linked to mechanical ventilation. Systemic infection occurred in one-fifth of patients and was more frequent with increasing duration of ICU admission. Direct complications of treatment and invasive procedures occurred infrequently. Life-threatening complications such as gastrointestinal bleeding and pulmonary embolism were very uncommon. Pulmonary morbidity predominates in patients with severe GBS admitted to the ICU. Attention to management of mechanical ventilation and weaning is important to minimize this complication of GBS. Other causes of morbidity in a tertiary center ICU are uncommon.     

Percutaneous dilational tracheostomy in neurosurgical patients

Introduction: Tracheostomy is often performed in patients requiring long-term mechanical ventilation after severe neurological injury. Percutaneous dilational tracheostomy (PDT) is an alternative to traditional surgical tracheostomy (TST) for creating a tracheostomy. We compared these techniques in neurosurgical patients and assessed the impact on cost and clinical course. Methods: We conducted a retrospective chart review of 81 neurosurgical patients treated with either PDT (n=43) or TST (n=38). Several clinical endpoints were examined, including days intubated prior to tracheostomy, length of hospital stay, procedural complications, and overall procedure costs. Results: No serious complications occurred with PDT, whereas two minor postoperative complications occurred in the TST group. The time from intubation to tracheostomy was 8 days for the PDT group versus 13 days for the TST group (p<0.001), and the time from intubation to discharge from the hospital was 20 days for the PDT group compared to 27 days for the TST group (p<0.005). In our institution, the average cost of PDT was $980.69 less than the cost for TST. Conclusion: PDT appear to have a low incidence of complications in neurosurgical patients and may shorten the length of hospitalization and the overall cost compared with TST.