Tracheotomy in severe TBI patients: sequelae and relation to vocational outcome

Abstract

The aim of the present study was to find the influence of performing tracheotomy on outcome of severe TBI patients. TBI patients, many of them intubated during the very acute phase post-injury, who remain unconscious for more than a few days, undergo tracheotomy to provide a reliable long term artificial airway. Tracheotomy, although being a simple elective surgical procedure, may have a negative influence on the rehabilitation process. Tracheotomy was performed in 25% (n=69) of 277 consecutive severe TBI patients admitted to the rehabilitation department during 3 years. In seven patients (10%), tracheotomy was performed immediately after injury due to cranio-facial trauma, in 18 patients (29%) due to respiratory disturbances, in 42 patients (55%) after prolonged intubation, and in two patients (6%) due to combined problems. Forty-five per cent of patients with tracheotomy suffered from respiratory disturbances and 8.6% from complications of tracheotomy. Longer periods of unconsciousness and mechanical ventilation were significantly associated with respiratory complications (p<0.0001 and p<0.001, respectively). However, presence of tracheotomies per se, did not affect vocational rehabilitation.

Saliva management options for difficult-to-wean people with tracheostomy following severe acquired brain injury (ABI): A review of the literature

“…The medical complications associated with prolonged tracheostomy include obstruction by secretions, accidental dislodgement, respiratory infections, hypergranulation, stenosis, fistulas and tracheomalacia [1][2][3][4][5][6]. People with longer-term tracheostomies encounter poorer self-image [7], increased psychological stress [8] and longer rehabilitation [2]. Additionally, in the authors' clinical experience there is increased family anxiety, reduced social access, increased institutionalization and fewer discharge options.…”

“…People with severe ABI can experience a broad range of neurological changes including reduced conscious state, respiratory or swallowing problems [2], which may impact on their ability to control airway secretions. Tracheostomy decannulation should occur when there is adequate control of airway secretions [10].…”

“…Managing a long-term tracheostomy requires cleaning, suctioning and general care for individuals and their carers and risks significant morbidity and potential mortality. The medical complications associated with prolonged tracheostomy include obstruction by secretions, accidental dislodgement, respiratory infections, hypergranulation, stenosis, fistulas and tracheomalacia [1][2][3][4][5][6]. People with longer-term tracheostomies encounter poorer self-image [7], increased psychological stress [8] and longer rehabilitation [2].…”

Feasibility of swallowing interventions for tracheostomized individuals with severely disordered consciousness following traumatic brain injury

“…impulsivity) [1][2][3][4][5]. Intubation and tracheotomy, procedures frequently needed following severe TBI, may also be associated with dysphagia [6][7][8]. The presence of any or all of the types of impairments described above may result in aspiration whereby secretions, food and/or liquid pass into the airway below the true vocal folds [9].…”

Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols

“…The positioning of a tracheostomy cannula following an acute episode of respiratory failure can help the management of patients who need long-term invasive mechanical ventilation, facilitating the aspiration of tracheal secretions, nursing and weaning from the mechanical support [1-3]. Once the subject is able to sustain spontaneous breathing, the primary steps of the rehabilitation programme include the safe removal of the tracheostomy cannula.…”