To investigate the timing of tracheotomy in patients with high-grade (Hun-Hess grade Ⅳ-Ⅴ) aneurysmal subarachnoid hemorrhage (aSAH) and its impact on clinical prognosis.

A retrospective analysis was conducted on 53 patients with aSAH admitted to Neurosurgery Department of Baoji Central Hospital from January 2015 to June 2020. The patients were divided into an ultra-early group (32 cases) and an early group (21 cases) according to the timing of tracheotomy. Patients in the ultra-early group underwent tracheostomy within 24 h after aSAH, while those in the early group underwent tracheostomy 1-7 d after aSAH. The incidence of complications related to the nervous system, respiratory system, tracheotomy, as well as indicators such as mechanical ventilation duration and NICU stay, were compared between the two groups. Neurological function recovery was evaluated using the modified Rankin scale (mRS) at 6 months after onset.

There was no significant difference in the occurrence of postoperative epilepsy, cerebral infarction, intracranial rebleeding, pneumothorax, urinary tract infection, sepsis, intracranial infection, incision infection, airway stenosis, subcutaneous emphysema, PCO₂, and bedsores between the two groups of patients. Compared with the early group, the incidence of postoperative pleural effusion, pulmonary infection, and deep vein thrombosis was reduced, the duration of mechanical ventilation, tube blockage, and NICU hospitalization was shortened, and blood gas levels of PO₂ were increased in the ultra-early group, with statistically significant differences (P<0.05). At a 6-month follow-up, there was no statistically significant difference in mRS scores and mortality rates between the two groups of patients (P>0.05).

Ultra early tracheostomy in high-grade aSAH patients can effectively reduce the incidence of pulmonary infection, improve respiratory function, ensure oxygen supply to tissues and organs, reduce mechanical ventilation time, shorten NICU hospitalization time, and do not increase the mortality rate and neurological dysfunction of aSAH surgery patients.