Severe secretion retention: a predictor of decannulation outcome in severe brain injury patients with tracheostomy

Abstract

BACKGROUND Identifying accurate predictors of decannulation outcome is essential to ensure safe and timesaving decannulation. Studies indicated hypopharyngeal secretion retention is closely associated with compromised airway protection and patients with it are less likely to be decannulated. However, data verifying the link between secretion retention and decannulation outcome are lacking. AIM The aim of this study was to identify the association between hypopharyngeal secretion-retention (indicated by Murray Secretion Scale [MSS]) and decannulation outcomes in a large cohort of severe acquired brain injury (sABI) patients with tracheotomy. To test the diagnostic performance of secretion retention in decision making of decannulation. DESIGN Retrospective cross-sectional study. SETTING The setting of the study is neurorehabilitation department in a tertiary teaching hospital. POPULATION A total of 144 adult patients with sABI and tracheostomy were retrospectively selected from the database from September 1, 2019, to August 31, 2021. METHODS The results of hypopharyngeal secretion-retention observed by fiberoptic endoscopy on the day that decision on decannulation was made were collected. The association between severity of secretion retention and decannulation outcomes was investigated through logistic regression, which was used to adjust covariates, including presence of food/liquid aspiration, decreased laryngeal sensation and conscious level. The optimal cut-off values of MSS for decannulation status prediction was determined by maximizing the Youden Index. RESULTS One hundred twenty-one patients were included in the sample. The age was 55.6±15.2 years, 84 (69.4%) patients were male. Eighty-four (69.4%) of them were successfully decannulated during their hospital stay. Multivariable logistic regression analysis indicated severe secretion retention (MSS level3) was independently associated with prolonged tracheostomy (adjusted odds ratio 65.23, 95% CI 6.58-646.35, P<0.001). The sensitivity and specificity of MSS level3 to assess the probability of prolonged decannulation were 78.4% and 96.4%, respectively. The area under the curve was 0.894 (95% CI 0.819-0.969). CONCLUSIONS Our results add to the evidence supporting screening of secretion retention severity in sABI population to identify patients at risk of prolonged tracheostomy. Whether decreasing secretion retention increases probability of successful decannulation deserves to be investigated by further study. CLINICAL REHABILITATION IMPACT This study could provide evidence for establishing objective decannulation criteria based on fiberoptic endoscopy and be helpful for implementing targeted rehabilitation interventions to promote successful decannulation.

The effects of regional anesthesia combined with awake delayed extubation in patients undergoing esophageal cancer surgery: a single-blind randomized controlled trial

“…The trauma and esophageal anastomosis at the neck after MIE would increase secretions. The poor pharyngeal clearance of secretions could lead to laryngeal penetration and aspiration, and aspiration pneumonia [9,10] and the patients of MIE in the early stages of anesthesia recovery usually have no su cient airway protection. Additionally, previous studies have reported severe secretion retention in patients with a tracheostomy tube than in those without.…”