Early versus standard tracheostomy in ventilated patients in neurosurgical intensive care unit: A randomized controlled trial.

INTRODUCTION: Tracheostomy is performed in patients with prolonged mechanical ventilation, who suffered catastrophic neurologic insult or upper airway obstruction. Thus far, there is no consensus on the optimal timing in performing a tracheostomy. This study aims to test whether early tracheostomy in mechanically ventilated patients in a neurosurgical setting would be associated with a shorter time of mechanical ventilation as compared to standard tracheostomy. METHODS: This single-center prospective randomized controlled trial was conducted at University Malaya Medical Centre from July 2019 to July 2021. The likelihood of prolonged ventilation was determined objectively using the TRACH score and the patient's clinical presentation. The outcomes measured were days of mechanical ventilation post-tracheostomy, days of neuro-intensive care unit stay, and days of hospital stay. Tracheostomy-related complications were collected. The data collected were analyzed using Statistical Package for the Social Sciences version 25 for Windows (SPSS Inc., Chicago, IL, USA). RESULTS: In all, 39 patients were randomly assigned. Of these, 20 were allocated to the early tracheostomy group (ET) and 19 were allocated to the standard tracheostomy group (ST). The demographic characteristics were similar between the groups. The primary outcome, mean (SD) days of mechanical ventilation post-tracheostomy, was statistically different in the 2 groups- early 11.9 (9.3) days, standard 18.9 (32.5) days; p = 0.014. There were comparable tracheostomy-related complications in both groups. CONCLUSION: Early tracheostomy is associated with a shorter duration of mechanical ventilation in a neurosurgical intensive care unit setting.

Laparoscopic versus open management of adult intussusception.

BACKGROUND: Laparotomy has been the traditional approach for the treatment of adult intussusception. The aim of the present study was to compare the short-term clinical outcomes of laparoscopic surgery to those of open surgery in adult patients with intussusception. METHODS: We retrospectively reviewed data of all adult patients with intussusception admitted to our hospital between 2007 and 2017. The patients' characteristics, presentation, operation details, postoperative outcomes and pathology were analyzed. Comparisons were made between the laparoscopic and open surgery procedures performed during the study period. RESULTS: Seventeen open and 20 laparoscopic-assisted resections were performed. No significant differences were found between the two groups for the following parameters: age (45.3 ± 16.8 vs. 54.9 ± 19.1, p = 0.160); gender (41 vs. 60% males, p = 0.330); American Society of Anesthesiologists score (p = 0.609); history of cardiovascular disease (5.9% vs. 5.6%, p = 0.950), COPD/asthma (0% vs. 5.6%, p = 0.950), diabetes (11.8% vs. 11.1%, p = 0.950), and renal impairment (5.9% vs. 0%, p = 0.486); body mass index (20.6 vs. 21.9, p = 0.433); timing of presentation (p = 1.000); type of intussusception (p = 0.658); type of procedures (p = 0.446); operative time (173.7 ± 45.4 vs. 191.5 ± 43.9, p = 0.329); and length of postoperative stay (6.7 ± 5.4 vs. 4.5 ± 1.1 days, p = 0.153). However, the open surgery group had fewer patients with hypertension (17.6% vs. 61.1%, p = 0.009) and demonstrated a delayed oral intake (4.0 ± 1.7 days vs. 2.5 ± 0.7 days, p = 0.010) and a higher comprehensive complication index (11.5 ± 27.1 vs. 0, p = 0.038). CONCLUSIONS: The laparoscopic approach was associated with earlier oral intake and a lower comprehensive complication index. It is a safe and feasible technique that confers the advantages of minimally invasive surgery. It can be considered the preferred surgical option when the surgical expertise is available.