Tracheal Decannulation Protocol in Patients Affected by Traumatic Brain Injury

Abstract

Introduction The frequency of tracheostomy in patients with traumatic brain injury (TBI) contrasts with the lack of objective criteria for its management. The study arose from the need for a protocol in the decision to remove the tracheal tube. Objective To evaluate the applicability of a protocol for tracheal decannulation. Methods A prospective study with 20 patients, ranging between 21 and 85 years of age (average 33.55), 4 of whom were women (20%) and 16 were men (80%). All patients had been diagnosed by a neurologist as having TBI, and the anatomical region of the lesion was known. Patients were evaluated following criteria for tracheal decannulation through a clinical evaluation protocol developed by the authors. Results Decannulation was performed in 12 (60%) patients. Fourteen (70%) had a score greater than 8 on the Glasgow Coma Scale and only 2 (14%) of these were not able to undergo decannulation. Twelve (60%) patients maintained the breathing pattern with occlusion of the tube and were successfully decannulated. Of the 20 patients evaluated, 11 (55%) showed no signs suggestive of tracheal aspiration, and of these, 9 (82%) began training on occlusion of the cannula. The protocol was relevant to establish the beginning of the decannulation process. The clinical assessment should focus on the patient's condition to achieve early tracheal decannulation. Conclusion This study allowed, with the protocol, to establish six criteria for tracheal decannulation: level of consciousness, respiration, tracheal secretion, phonation, swallowing, and coughing.

Decanulação: indicadores sociodemográficos, clínicos e fonoaudiológicos preditivos de sucesso

“…The mean and median ages observed in this study were lower in the decannulated than in the non-decannulated patients, with statistical relevance, suggesting a correlation between age and success in decannulation. Some studies have described the variables age and gender as secondary factors associated with success in decannulation (9,11,12) ; however, two studies have identified significant correlation between age and success in decannulation, with patients with more advanced ages showing greater risks of process failure (18,26) , because the older the patient, the greater the possibility of comorbidities, which may interfere with the tracheostomy weaning process in this population (25) .…”

“…The following criteria are suggested for indication and success in decannulation: ability to tolerate cuff deflation for 24h (9,10) ; presence of respiratory muscle strength and resistance (11,12) ; effective cough with ability to remove lung secretions (7,(9)(10)(11)(13)(14)(15) ; voluntary and reflexive cough (7,10,11,13) ; intact upper airways (5,9,13,15) ; absence of glottic or subglottic stenosis (16,17) ; preserved swallowing capacity (7,9,(11)(12)(13)(15)(16)(17) ; performance of the Blue Dye test (6,11,13,18) ; absence of previous head and neck surgery (7,11) ; use of phonation valve (11,14) ; tolerance to tracheostomy occlusion, with or without need for oxygen therapy (9,11,12,15,17) ; stable oxygen saturation for longer than 24h after tube occlusion (7,(9)(10)(11)…”

“…Aiming to avoid or minimize functional complications resulting from tracheostomy, which generate significant emotional impact on the quality of life of patients and on family relationships (19) , the tube removal process should be initiated as early as possible, and speech-language pathology (SLP) assessment and monitoring are essential in identifying some criteria that contribute to the success in weaning, such as functional swallowing, ability to protect the lower airways (7,9,(13)(14)(15)20,21) , absence of pulmonary aspiration, spontaneous swallowing of saliva, and facilitation of verbal and non-verbal communication (12,19) .…”

Processo de decanulação em pacientes acometidos por traumatismo cranioencefálico: estudo realizado em um hospital de trauma, na região metropolitana de Belém, PA

“…10 Foram constituídos dois grupos: de estudo e controle, com 30 pacientes acometidos por TCE, sendo 83,3% do gênero masculino e 16,7% do gênero feminino, em ambos os grupos. A idade dos pacientes variou de 18 a 53 anos, com mé-dia de 32 anos.…”

Avaliação fonoaudiológica para decanulação traqueal em pacientes acometidos por traumatismo cranioencefálico

“…The authors correlated the six criteria with decannulation and, following the data analysis, observed that all criteria were significant when deciding for the decannulation. This led to the creation of the Speech-Language Pathology Protocol for Tracheal Decannulation (SPTD) of patients suffering from TBI (19) . This study aimed to describe the effect of the SLP assessment in the tracheal decannulation process in two groups of people with tracheostomy and traumatic brain injury (TBI).…”