To compare the effect of early vs. late tracheostomy tube change on the incidence of infection in Traumatic Brain Injury patients in ICU.

Respiratory tract infections are the most common nosocomial infections encountered in ICU patients. Common source of these infections are indwelling tubes and catheters. Despite of the aseptic and hygiene practices by the ICU staff there has been only a moderate decrease in the infection rate.In  earlier studies tube were changed after 7 days. Biofilms are formed within 7 days of insertion but colonization begins as early as 12 hr and most abundant in 96 hr.  So we hypothesized that changing of tracheostomy tube within 96 hr to prevent further biofilm formation and reduces subsequent acquired infection.

After obtaining written informed consent from patient guardian or relative,  patients will be divided randomly into two groups (n=40): Group E tracheostomy tube changed on every 4th day; Group L tracheostomy tube will be changed on every 7th day. Baseline parameter of infection like fever, TLC and culture report  are documented. Tracheal aspirate culture will be send before tube change along with culture of blood, urine or any other potential source of infection. Any raise in temperature and TLC will be documented. Antibiotcs will be changed based on culture and sensitive report.