Abstract
Objective
To identify the effect of some clinical characteristics of severe acquired brain injury
(sABI) patients on decannulation success during their intensive rehabilitation unit
(IRU) stay.
Design
Nonconcurrent cohort study.
Setting
Don Gnocchi Foundation Institute.
Participants
Patients (N=351) with sABI and tracheostomy were retrospectively selected from the
database of the IRU of the Don Gnocchi Foundation Institute.
Main Outcome Measures
Potential predictors of decannulation were screened from variables collected at admission
during clinical examination, conducted by trained and experienced examiners. The association
between clinical characteristics and decannulation status was investigated through
a Cox regression model. Kaplan-Meier curves were then created for time-event analysis.
Results
Among the patients (mean age, 64.1±15.5y), 54.1% were decannulated during their IRU
stay. Absence of pulmonary infections (P<.001), sepsis (P=.001), tracheal alteration at the fibrobronchoscopy examination (P=.004) and a higher Coma Recovery Scale-Revised (CRS-R) score (P<.001) or a better state of consciousness at admission (P=.001) were associated with a higher probability of decannulation.
Conclusions
Fibrobronchoscopy assessment of patency of airways and accurate evaluation of the
state of consciousness using the CRS-R are relevant in this setting of care to better
identify patients who are more likely to have the tracheostomy tube removed. These
results may help clinicians choose the appropriate timing and intensity of rehabilitation
interventions and plan for discharge.
Keywords
List of abbreviations:
BDT (balloon dilatation tracheotomy), CRS-R (Coma Recovery Scale-Revised), DoC (disorders of consciousness), E-MCS (emerging from minimal consciousness state), FBS (fibrobronchoscopy), GCS (Glasgow Coma Scale), HR (hazard ratio), IRU (intensive rehabilitation unit), LOS (length of stay), MCS (minimal consciousness state), sABI (severe acquired brain injury), UWS (unresponsive wakefulness state)To read this article in full you will need to make a payment
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References
- [Tracheotomy in brain injured patients: which patients? Why? When? How?] [French].Ann Fr Anesth Reanim. 2005; 24: 659-662
- How is mechanical ventilation employed in the intensive care unit? An international utilization review.Am J Respir Crit Care Med. 2000; 161: 1450-1458
- Parameters influencing tracheostomy decannulation in patients undergoing rehabilitation after severe acquired brain injury (sABI).Int Arch Otorhinolaryngol. 2017; 21: 382-389
- Tracheotomy in severe TBI patients: sequelae and relation to vocational outcome.Brain Inj. 2001; 15: 531-536
- Clinical criteria for tracheostomy decannulation in subjects with acquired brain injury.Respir Care. 2017; 62: 1255-1263
- Increased frequency of obstructive airway abnormalities with long- term tracheostomy.Chest. 1993; 104: 136-138
- Rehabilitation of traumatic brain injury in Italy: a multi-centred study.Brain Inj. 2012; 26: 27-35
- Development of the decannulation prediction tool in patients with dysphagia after acquired brain injury.J Am Med Dir Assoc. 2019; 20: 470-475
- Tracheal decannulation proto- col in subjects affected by traumatic brain injury.Int Arch Otorhinolaryngol. 2014; 18: 108-114
- [Bronchoscopy-guided decannulation of tracheostomy in patients with brain injury] [Hungarian].Orv Hetil. 2014; 155: 1108-1112
- Dysphagic patients with tracheotomies: a multidisciplinary approach to treatment and decannulation management.Dysphagia. 2007; 22: 20-29
- Determinants of tracheostomy decannulation: an international survey.Crit Care. 2008; 12: R26
- The minimally conscious state and recovery potential: a follow-up study 2 to 5 years after traumatic brain injury.Arch Phys Med Rehabil. 2005; 86: 746-754
- Implications of extubation delay in brain-injured patients meeting standard weaning criteria.Am J Respir Crit Care Med. 2000; 161: 1530-1536
- Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols.Multidiscip Respir Med. 2014; 9: 36
- The practice of tracheostomy decannulation-a systematic review.J Intensive Care. 2017; 5: 38
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.J Clin Epidemiol. 2008; 61: 344-349
- The JFK coma recovery scale- revised: measurement characteristics and diagnostic utility.Arch Phys Med Rehabil. 2004; 85: 2020-2029
- An Italian multicentre validation study of the coma recovery scale revised.Eur J Phys Rehabil Med. 2015; 51: 627-634
- La gestione della cannula tracheostomica nelle persone con grave cerebrolesione acquisita: consenso a un protocollo condiviso [Italian].MR Giornale Italiano di Medicina Riabilitativa. 2013; 27: 9-16
- Pediatric laryngotracheal stenosis.J Pediatr Surg. 1984; 19: 699-704
- Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome.Intensive Care Med. 2003; 29: 845-848
- Belgian Association of Pneumology and Belgian Association of Cardiothoracic Surgery. Tracheotomy: clinical review and guidelines.Eur J Cardiothorac Surg. 2007; 32: 412-421
- Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning.Chest. 1996; 110: 1566-1571
- Rehabilitation outcome of patients with severe and prolonged disorders of consciousness after aneurysmal subarachnoid hemorrhage (aSAH).Clin Neurol Neurosurg. 2013; 115: 2136-2141
- Peak flow rate during induced cough: a predictor of successful decannulation of a tracheotomy tube in neurosurgical patients.Am J Crit Care. 2010; 19: 278-284
- Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research.Arch Phys Med Rehabil. 2010; 91: 1795-1813
- Reliability and diagnostic characteristics of the JFK coma recovery scale-revised: exploring the influence of rater's level of experience.J Head Trauma Rehabil. 2010; 25: 349-356
- A brief overview of the Coma Recovery Scale-revised: updates from the COMBI.J Head Trauma Rehabil. 2015; 30: 143-145
- Score on Coma Recovery Scale-Revised at admission predicts outcome at discharge in intensive rehabilitation after severe brain injury.Brain Inj. 2018; 32: 730-734
- Intensive Rehabilitation Unit Study Group of the IRCCS Don Gnocchi Foundation, Italy. Improvement on the Coma Recovery Scale-Revised During the first four weeks of hospital stay predicts outcome at discharge in intensive rehabilitation after severe brain injury.Arch Phys Med Rehabil. 2018; 99: 914-919
- Importance of flexible bronchoscopy in decannulation of tracheostomy patients.Rev Col Bras Cir. 2015; 42: 75-80
Article info
Publication history
Published online: May 16, 2020
Footnotes
Supported by Current Research Funds (2019) from the Italian Ministry of Health.
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
