Parameters Influencing Tracheostomy Decannulation in Patients Undergoing Rehabilitation after severe Acquired Brain Injury (sABI)

Abstract

Introduction Tracheostomy weaning in patients who suffered a severe acquired brain injury is often a challenge and decannulation failures are not uncommon. Objective Our study objective is to describe the decannulation failure rate in patients undergoing rehabilitation following a severe acquired brain injury (sABI); to describe the factors associated with a successful tube weaning. Methods We conduct a retrospective analysis of charts, consecutively retrieved considering a 3-year window. Variables analyzed were: age, sex, body mass index (BMI), Glasgow Coma Scale (GCS), cause of hospitalization (stroke, trauma, cardiac arrest), date of the pathological event, gap between the index event and the first day of hospitalization, duration of Neurorehabilitation Ward hospitalization, comorbidities, chest morphological alteration, kind of tracheostomy tube used (overall dimension, cap, fenestration), SpO2, presentation and quantification of pulmonary secretion, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respiratory frequency and pattern, cardiac frequency, presence of spontaneous cough, cough strength, and blood gas analysis. Results We analyzed 45 tracheostomised sABI patients following stroke, trauma, or cardiac arrest. The weaning success percentage was higher in Head Trauma patients and in patients presenting positive spontaneous cough. Failures seem to be associated with presence of secretions and anoxic brain damage. GCS seemed not related to the decannulation outcome. Conclusions Parameters that could be used as positive predictors of weaning are: mean expiratory pressure, presence of spontaneous cough, and cough strength. Provoked cough and GCS were not predictive of weaning success.

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

“…71 It is important to remember that it is a hypothetical score and requires validation in daily practice. Two recent studies, a systematic review and a retrospective study, associated positive spontaneous cough in patients with TBI as a predictor of the success of decannulation, 72,73 a result that is consistent with the literature reviewed. In general, decannulation is more often individualized than protocol based.…”

The role of polysomnography in decannulation of children with brain and spinal cord injuries

“…We did not find an association between successful decannulation and demographic factors, etiology of injury, injury characteristics, or timeline from initial injury to selected events, although there was a trend toward a younger mean age in the unsuccessful decannulation group. We did not look at the relationship between findings on imaging or Glasgow Coma Scale and decannulation, which has been reported in other studies . Given our small sample size, further studies are needed to determine what demographic factors or factors related to underlying diagnosis may be associated with decannulation success as this could help to tailor decannulation protocols to specific patient populations.…”

“…other studies. [16][17][18] Given our small sample size, further studies are needed to determine what demographic factors or factors related to underlying diagnosis may be associated with decannulation success as this could help to tailor decannulation protocols to specific patient populations.…”

Using Routinely Gathered Clinical Data to Develop a Prognostic Online Tool for Decannulation in Subjects With Acquired Brain Injury

“…Several previous studies have investigated predictors of decannulation in subjects with acquired brain injury. However, many studies are of poor quality (eg, small study populations, or the use of univariate analyses), 4,5,7,8,20,[27][28][29] thus limiting the conclusions that may be drawn from those studies. 30 A few recent studies have investigated the prediction of decannulation in larger study populations of subjects with neurological diseases and acquired brain injury using routinely gathered clinical data and applying multivariable analytical methods.…”

“…3 By using clinical data, which are routinely gathered as part of everyday practice, it is possible to develop prognostic models that can be implemented directly into clinical practice because they do not require any changes in practice or the purchase of new medical equipment. 3 Several small studies have reported that swallowing capability, [4][5][6] coughing, 5,7 and early rehabilitation 8 were predictors of decannulation in subjects with acquired brain injury. However, these studies are of poor quality and do not provide an applicable prognostic tool.…”