Tracheostomy Decannulation and Disorders of Consciousness Evolution

Bellón, Pablo; Bosso, Mauro; Echegaray, Joaquín E Carnero; Larocca, Florencia; Primosich, Walter A; Pavón, Hernán; Yorio, Rodrigo Di; Cancino, Jorge

doi:10.4187/respcare.08301

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…The selected studies included an overall sample of 2844 patients with disorders of consciousness (eight in coma, 0.3%; 1774 in VS/UWS, 62.4%; 926 in MCS, 32.6%; 136 having emerged from MCS [eMCS], 4.7%) caused by different aetiologies (traumatic brain injury 992, 34.9%; non‐traumatic brain injury 1852, 65.1%), with a mean age of 48 years (not available in two studies); 1825 (64.2%) patients were male (not available in one study). Most studies [3, 5, 13–19, 21, 23, 24, 26, 31, 32, 35, 36, 39, 40] investigated the prognostic role of demographic, clinical and anamnestic factors. Some studies also included neurophysiological [5, 16, 19, 20, 22, 23, 25, 28, 30, 32, 33, 38] or neuroimaging [15, 26, 29, 37–39] investigations.…”

Section: Resultsmentioning

confidence: 99%

“…The details of the included studies are reported in Table S1. Most studies [3,5,14,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] enrolled patients in Europe (23/30, 77%), whereas five studies [15,[36][37][38][39] (16%) included patients from China, and two studies [13,40] (7%) included patients from the Americas.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Long‐term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta‐analytic study

Magliacano

Bellis

Panico

et al. 2023

Euro J of Neurology

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Background and purposeThe prognosis of prolonged (28 days to 3 months post‐onset) disorders of consciousness (pDoC) due to anoxic brain injury is uncertain. The present study aimed to evaluate the long‐term outcome of post‐anoxic pDoC and identify the possible predictive value of demographic and clinical information.MethodThis is a systematic review and meta‐analysis. The rates of mortality, any improvement in clinical diagnosis, and recovery of full consciousness at least 6 months after severe anoxic brain injury were evaluated. A cross‐sectional approach searched for differences in baseline demographic and clinical characteristics between survivors and non‐survivors, patients improved versus not improved, and patients who recovered full consciousness versus not recovered.ResultsTwenty‐seven studies were identified. The pooled rates of mortality, any clinical improvement and recovery of full consciousness were 26%, 26% and 17%, respectively. Younger age, baseline diagnosis of minimally conscious state versus vegetative state/unresponsive wakefulness syndrome, higher Coma Recovery Scale Revised total score, and earlier admission to intensive rehabilitation units were associated with a significantly higher likelihood of survival and clinical improvement. These same variables, except time of admission to rehabilitation, were also associated with recovery of full consciousness.ConclusionsPatients with anoxic pDoC might improve over time up to full recovery of consciousness and some clinical characteristics can help predict clinical improvement. These new insights could support clinicians and caregivers in the decision‐making on patient management.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Long‐term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta‐analytic study

Magliacano

Bellis

Panico

et al. 2023

Euro J of Neurology

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Predictors of long-term decannulation in patients with disorders of consciousness

Chen,

Aishan,

Fan

et al. 2023

Front. Neurol.

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PurposeThe predictors of tracheostomy decannulation in patients with disorders of consciousness (DOC) are not comprehensively understood, making prognosis difficult. The primary objective of this study was to identify predictors of tracheostomy decannulation in patients with disorders of consciousness (DOC). The secondary aim was to evaluate the feasibility and safety of the modified Evans blue dye test (MEBDT) in tracheostomized DOC patients.MethodsThis retrospective study included all patients with disorders of consciousness (DOC) who underwent tracheostomy and were admitted between January 2016 and September 2022. Age, sex, etiology, initial Glasgow coma scale (GCS), initial Coma Recovery Scale-Revised (CRS-R), diagnosis of unresponsive wakefulness syndrome (UWS) or minimal consciousness state (MCS), MEBDT, initial modified Rankin scale (mRS), and initial Functional Oral Intake Scale (FOIS) were collected upon study enrollment. The relationship between clinical characteristics and cannulation status was investigated through a Cox regression model.ResultsA total of 141 patients were included in the study. The average age of these patients was 52.5 ± 16.7 years, with 42 (29.8%) being women. During the study period, 86 subjects (61%) underwent successful decannulation. Univariate analysis revealed that decannulated patients exhibited a significantly better conscious state compared to those without decannulation (CRS-R: p < 0.001; GCS: p = 0.023; MCS vs. UWS: p < 0.001). Additionally, a negative modified Evans blue dye test (MEBDT) result was significantly associated with tracheostomy decannulation (p < 0.001). In the multivariate analysis, successful decannulation was associated with a higher level of consciousness (MCS vs. UWS, p < 0.001, HR = 6.694) and a negative MEBDT result (negative vs. positive, p = 0.006, HR = 1.873). The Kaplan–Meier analysis further demonstrated that MEBDT-negative patients and those in the MCS category had a higher probability of decannulation at 12 months (p < 0.001).ConclusionThe findings of this study indicate that a negative MEBDT result and a higher level of consciousness can serve as predictive factors for successful tracheostomy decannulation in DOC patients.

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The effect and mechanisms of music therapy on the autonomic nervous system and brain networks of patients of minimal conscious states: a randomized controlled trial

2023

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IntroductionMusic therapy has been employed as an alternative treatment modality for the arousal therapy of patients with disorders of consciousness (DOC) in clinical settings. However, due to the absence of continuous quantitative measurements and the lack of a non-musical sound control group in most studies, the identification of the specific impact of music on DOC patients remains challenging. In this study, 20 patients diagnosed with minimally consciousness state (MCS) were selected, and a total of 15 patients completed the experiment.MethodsAll patients were randomly assigned to three groups: an intervention group (music therapy group, n = 5), a control group (familial auditory stimulation group, n = 5), and a standard care group (no sound stimulation group, n = 5). All three groups received 30 min of therapy five times a week for a total of 4 weeks (20 times per group, 60 times in total). Autonomic nervous system (ANS) measurements, Glasgow Coma Scale (GCS), and functional magnetic resonance—diffusion tensor imaging (fMRI-DTI) were used to measure the peripheral nervous system indicators and brain networks, and to evaluate patients’ behavior levels.ResultsThe results reveal that PNN50 (p = 0.0004**), TP (p = 0.0003**), VLF (p = 0.0428**), and LF/HF (p = 0.0001**) in the music group were significantly improved compared with the other two groups. Such findings suggest that the ANS of patients with MCS exhibits higher activity levels during music exposure compared to those exposed to family conversation or no auditory stimulation. In fMRI-DTI detection, due to the relative activity of ANS in the music group, the ascending reticular activation system (ARAS) in the brain network also exhibited significant nerve fiber bundle reconstruction, superior temporal gyrus (STG), transverse temporal gyrus (TTG), inferior temporal gyrus (ITG), limbic system, corpus callosum, subcorticospinal trace, thalamus and brainstem regions. In the music group, the reconstructed network topology was directed rostrally to the diencephalon’s dorsal nucleus, with the brainstem’s medial region serving as the hub. This network was found to be linked with the caudal corticospinal tract and the ascending lateral branch of the sensory nerve within the medulla.ConclusionMusic therapy, as an emerging treatment for DOC, appears to be integral to the awakening of the peripheral nervous system-central nervous system based on the hypothalamic-brainstem-autonomic nervous system (HBA) axis, and is worthy of clinical promotion. The research was supported by the Beijing Science and Technology Project Foundation of China, No. Z181100001718066, and the National Key R&D Program of China No. 2022YFC3600300, No. 2022YFC3600305.

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Tracheostomy Decannulation and Disorders of Consciousness Evolution

Cited by 3 publications

References 23 publications

Long‐term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta‐analytic study

Long‐term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta‐analytic study

Predictors of long-term decannulation in patients with disorders of consciousness

The effect and mechanisms of music therapy on the autonomic nervous system and brain networks of patients of minimal conscious states: a randomized controlled trial

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