Predictive factors for tracheostomy in patients with spontaneous supratentorial haemorrhage

Background and Purpose: Up to 30% of patients with supratentorial intracerebral hemorrhage (ICH) require mechanical ventilation during the course of treatment. For these patients, tracheostomy is necessary in cases of protracted weaning. As only limited data exists about predictors for a tracheostomy in patients with ICH, the aim of this study was to investigate the incidence of tracheostomy and clinical findings that increase the risk for a tracheostomy in patients with supratentorial hemorrhage.

Methods: A total of 392 patients with supratentorial ICH were analyzed. The parameters age, gender, Glasgow Coma Scale on admission, ganglionic or non–ganglionic localization, presence of ventricular hemorrhage, hydrocephalus, and hematoma volume were investigated. The effects on the end-point tracheostomy were analyzed using multivariate regression analyses.

Results: The overall need for tracheostomy was 9.9%, in patients with ganglionic hemorrhage 16.3%, in patients with non–ganglionic hemorrhages 2.8%. The risk for tracheostomy was increased tenfold in patients who developed hydrocephalus. The presence of ventricular blood, in general, showed no significant impact on the need for tracheostomy, whereas hemorrhage extending into the third and fourth ventricles in conjunction with hydrocephalus increased the risk for tracheostomy. The hematoma volume correlated positively with the risk for tracheostomy.

Conclusions: Our study demonstrates that approximately 10% of patients with ICH require tracheostomy during the course of their disease. Ganglionic hemorrhages and the development of hydrocephalus are predisposing factors for tracheostomy.