Association between Paroxysmal Sympathetic Hyperactivity and tracheostomy weaning in Traumatic Brain Injury

Ringrose, Hollie; Brown, Mary F.; Walton, Krystyna; Sivan, Manoj

doi:10.3233/nre-172276

Cited by 9 publications

(6 citation statements)

References 11 publications

(7 reference statements)

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“…The patients with severe injury GCS at admission had higher rate of long-term tracheostomy. This is in keeping with other studies (15)(16)(17). These patients remain as inpatients for a longer duration in any acute ward and need care in a dedicated rehabilitation unit where the complexity of care (including managing the expectations of family and friends) needs to be managed.…”

Section: Discussionsupporting

confidence: 93%

“…This helped to facilitate discharge planning and presumably reduced the complexity of long-term care for these patients. The common reasons for delay in tracheostomy weaning and decannulation were increased secretion load and chest infections, as observed in other studies (15,16). Managing these problems requires a MDT of professionals trained in tracheostomy care, which includes a medical team, physiotherapists, speech and language therapists and specialist nurses.…”

Section: Discussionmentioning

confidence: 77%

See 1 more Smart Citation

Retrospective analysis of functional and tracheostomy (decannulation) outcomes in patients with brain injury in a hyper-acute rehabilitation unit

Cheng¹,

Mitton²,

Walton³

et al. 2019

J Rehabil Med-CC

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Objectives Hyper-Acute Rehabilitation Units (HA-RUs) provide multidisciplinary rehabilitation to patients with acute neurological injuries. This includes managing patients with tracheostomies. This is the first study of its kind to examine clinical outcomes in patients with brain injury and tracheostomy managed in a HARU. Methods Retrospective analysis of clinical outcomes in tracheostomy patients admitted to a HARU over a 2-year period. Results A total of 208 patients were admitted to the HARU, of whom 99 (60 males and 39 females) had a tracheostomy either at admission or during their stay in the HARU. Mean Glasgow Coma Scale score at admission was 11 (range 5-15) and at discharge was 13 (range 8-15). Mean Functional Independence Measure and Functional Assessment Measure (FIM+FAM) score improved from 52 at admission to 95 at discharge. Mean FIM+FAM cognitive admission cognitive sub-score improved from 23 to 42, and mean motor sub-score from 29 to 42. Changes in scores were deemed to be clinically significant as per thresholds reported in the literature. Of the total patients in this study, 79% were successfully decannulated and 21% needed long-term tracheostomy. Conclusion Patients with tracheostomy following brain injury can be appropriately managed in a HARU and show clinically significant improvement in functional outcomes. LAY ABSTRACT A Hyper-Acute Rehabilitation Unit (HARU) provides rehabilitation to patients with sudden neurological injury, such as traumatic brain injury or stroke. In order to maintain a safe airway some of these patients have an artificial tube inserted into the trachea through an opening in the neck. This procedure is called a tracheostomy.This study analysed outcomes in tracheostomy patients admitted to a HARU over a 2-year period. A total of 208 patients were admitted to the unit, of whom 99 had a brain injury and had had a tracheostomy, either at admission or during their stay in the HARU. Functional activity, measured using Functional Independence Measure and Functional Assessment Measure (FIM+FAM) scales, showed significant improvement in both physical and mental ability in these patients. The tracheostomy tubes were removed successfully in 79% of patients as they became more independent and able to maintain their airway. However, long-term tracheostomy was needed in 21% of patients. This study shows that patients who have a tracheostomy following an acute neurological injury can be managed appropriately in a HARU and improve in functional ability.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 77%

Retrospective analysis of functional and tracheostomy (decannulation) outcomes in patients with brain injury in a hyper-acute rehabilitation unit

Cheng¹,

Mitton²,

Walton³

et al. 2019

J Rehabil Med-CC

View full text Add to dashboard Cite

show abstract

“…Researchers also use the clinical features severity scale (CFSS) to quantify clinical features and show that PSH is more likely to develop in patients with temperatures over 38.0 • C, or rising, during the first 24-72 h post-injury (54). In addition, some unusual features deserve attention: hot or painful joints in PSH may be caused by heterotopic ossification, PSH is associated with prolonged tracheostomy weaning in severe TBI, and the use of tracheostomy might be independently associated with an increased incidence of PSH (41,55,56).…”

Section: Clinical Featuresmentioning

confidence: 99%

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

et al. 2020

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“…Several studies have commented on the gap in ongoing tracheostomy management from the critical care unit to the ward when patients are stepped down. 18,29 The MDT tracheostomy team spans this gap, and in this study, there was no change in the frequency or core personnel involved in a patient's care when stepped down from a critical care to a ward setting.…”

Section: Discussionmentioning

confidence: 67%

Multidisciplinary team management of tracheostomy procedures in neurocritical care patients: our experience over 17 years in a quaternary centre

et al. 2021

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Objective Tracheostomy in the neurocritical care population is associated with poorer outcomes. This study hypothesised that a multidisciplinary approach to tracheostomy care can improve outcomes. Methods This study was a prospective longitudinal study of all tracheostomised patients in the neurocritical care units of a quaternary centre over 17 years. All patients were managed by a tracheostomy team with a constant core membership of an intensive care consultant, speech and language therapist, and physiotherapist with consultant ENT input. Results A total of 51 per cent of patients were decannulated in hospital at an average of 48 (neuromedical) and 57.6 (neurosurgical) days. Of the 42 per cent of patients transferred to another facility with a tracheostomy tube in situ, 37.5 per cent were at an advanced stage of tracheostomy weaning. Complication rates were low at 4.8 per cent with no tracheostomy associated mortalities. Conclusion A multidisciplinary approach can enable good outcomes in the neurocritical care population. Consistency of care spanning the step-down from critical to ward-level care is crucial to improving outcomes.

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Association between Paroxysmal Sympathetic Hyperactivity and tracheostomy weaning in Traumatic Brain Injury

Abstract: This is the first study to demonstrate that PSH is associated with prolonged tracheostomy weaning in severe TBI. Awareness of this association should enable those planning rehabilitation to set realistic goals for a patient's tracheostomy weaning programme.

Cited by 9 publications

References 11 publications

Retrospective analysis of functional and tracheostomy (decannulation) outcomes in patients with brain injury in a hyper-acute rehabilitation unit

Retrospective analysis of functional and tracheostomy (decannulation) outcomes in patients with brain injury in a hyper-acute rehabilitation unit

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

Multidisciplinary team management of tracheostomy procedures in neurocritical care patients: our experience over 17 years in a quaternary centre

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