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Decannulation After a Severe Acquired Brain Injury

      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)
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