Retrospective analysis of patients with immediate decannulation in severe acquired brain injury (RAPID-SABI)

Robbert-Jan van Hooff; Mette Lindelof; Emma Ghaziani; Trine Hørmann Thomsen; Christina Kruuse; Christian Gunge Riberholt; Charlotte Rath

doi:10.2340/jrm-cc.v8.42068

Authors

Robbert-Jan van Hooff Department of Brain and Spinal Cord Injury, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
Mette Lindelof Department of Brain and Spinal Cord Injury, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
Emma Ghaziani Department of Brain and Spinal Cord Injury, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
Trine Hørmann Thomsen Department of Brain and Spinal Cord Injury, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
Christina Kruuse Department of Brain and Spinal Cord Injury, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark; Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
Christian Gunge Riberholt Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
Charlotte Rath Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

DOI:

https://doi.org/10.2340/jrm-cc.v8.42068

Keywords:

severe acquired brain injury, tracheostomy, decannulation

Abstract

Objective: To examine an early decannulation protocol in adult severe acquired brain injury (SABI) patients.

Design: Retrospective, observational cohort study.

Subjects/patients: Tracheotomized SABI patients ≥ 18 years admitted to a neurorehabilitation unit.

Methods: Primary outcome measure was difference in survival rate within first year of discharge. Secondary outcome measures were respiratory infections treated with antibiotics, rate of re-cannulation, time from admission to decannulation, length of stay, difference in rate of re-admission due to pneumonia within first year of discharge and difference in rate of tracheal tube dependency within first year of discharge.

Results: No statistical significance in survival rate within the first 12 months from discharge was found. Median time from admission to decannulation was 32 days (interquartile range [IQR] 14–61) vs 9 days (IQR 0–13) in the control and intervention group, respectively (p < 0.0003). Median length of stay was 66 days (IQR 54–92) in the control group vs 60 (IQR 48–75) days in the intervention group (p = 0.168).

Conclusion: A new early decannulation protocol omitting evaluation of tolerance to tracheostomy tube capping and fiberoptic endoscopic evaluation of swallowing was non-inferior to previous procedures in survival rate within first year of discharge. The early decannulation protocol allowed for significantly earlier decannulation.

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References

Perin C, Meroni R, Rega V, Braghetto G, Cerri CG. Parameters influencing tracheostomy decannulation in patients undergoing reha-bilitation after severe acquired brain injury (sABI). Int Arch Otorhinolaryngol 2017; 21: 382–389. DOI: https://doi.org/10.1055/s-0037-1598654

https://doi.org/10.1055/s-0037-1598654 DOI: https://doi.org/10.1055/s-0037-1598654

Christopher K. Tracheostomy decannulation. Respir Care 2005; 50: 538–541.

Morris PE, Griffin L, Berry M, Hite D, Haponik, E, Berry M, et al. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci 2011; 341: 373–377. DOI: https://doi.org/10.1097/MAJ.0b013e31820ab4f6

https://doi.org/10.1097/MAJ.0b013e31820ab4f6 DOI: https://doi.org/10.1097/MAJ.0b013e31820ab4f6

Rabinstein AA, Wijdicks EFM. Outcome of survivors of acute stroke who require prolonged ventilatory assistance and tracheosto-my. Cerebrovasc Dis 2004; 18: 325–331. DOI: https://doi.org/10.1159/000080771

https://doi.org/10.1159/000080771 DOI: https://doi.org/10.1159/000080771

Wahlster S, Sharma M, Chu F. Outcomes after tracheostomy in patients with severe acute brain injury: a systematic review and meta-analysis. Neurocrit Care 2021; 34: 956–967. DOI: https://doi.org/10.1007/s12028-020-01109-9

https://doi.org/10.1007/s12028-020-01109-9 DOI: https://doi.org/10.1007/s12028-020-01109-9

Choate K, Barbetti J, Curry J. Tracheostomy decannulation failure rate following critical illness: a prospective descriptive study. Aust Crit Care 2009; 22: 8–15. DOI: https://doi.org/10.1016/j.aucc.2008.10.002

https://doi.org/10.1016/j.aucc.2008.10.002 DOI: https://doi.org/10.1016/j.aucc.2008.10.002

Ceriana P, Carlucci A, Navalesi P, Rampulla C, Delmastro M, Piaggi GC, et al. Weaning from tracheostomy in long-term mechani-cally ventilated patients: feasibility of a decisional flowchart and clinical outcome. Intensive Care Med 2003; 29: 845–848. DOI: https://doi.org/10.1007/s00134-003-1689-z

https://doi.org/10.1007/s00134-003-1689-z DOI: https://doi.org/10.1007/s00134-003-1689-z

Morris LL, McIntosh E, Whitmer A. The importance of tracheostomy progression in the intensive care unit. Crit Care Nurse 2014; 34: 40–48. DOI: https://doi.org/10.4037/ccn2014722

https://doi.org/10.4037/ccn2014722 DOI: https://doi.org/10.4037/ccn2014722

O’Connor HH, White AC. Tracheostomy decannulation. Respir Care 2010; 55: 1076–1081.

Law JH, Barnhart K, Rowlett W, De la Rocha O, Lowenberg S. Increased frequency of obstructive airway abnormalities with long-term tracheostomy. Chest 1993; 104: 136–8. DOI: https://doi.org/10.1378/chest.104.1.136

https://doi.org/10.1378/chest.104.1.136 DOI: https://doi.org/10.1378/chest.104.1.136

Lanini B, Binazzi B, Romagnoli I, Chellini E, Pianigiani L, Tofani A, et al. Tracheostomy decannulation in severe acquired brain injury patients: the role of flexible bronchoscopy. Pulmonology 2023: 29(Suppl 4): S80–5. DOI: https://doi.org/10.1016/j.pulmoe.2021.05.006

https://doi.org/10.1016/j.pulmoe.2021.05.006 DOI: https://doi.org/10.1016/j.pulmoe.2021.05.006

Bösel J. Tracheostomy in stroke patients. Curr Treat Options Neurol 2014; 16: 274. DOI: https://doi.org/10.1007/s11940-013-0274-1

https://doi.org/10.1007/s11940-013-0274-1 DOI: https://doi.org/10.1007/s11940-013-0274-1

Santus P, Gramegna A, Radovanovic D, Raccanelli R, Valenti V, Rabbiosi D, et al. A systematic review on tracheostomy decannula-tion: a proposal of a quantitive semiquantitive clinical score. BMC Pulm Med 2014;15(14):201. DOI: https://doi.org/10.1186/1471-2466-14-201

https://doi.org/10.1186/1471-2466-14-201 DOI: https://doi.org/10.1186/1471-2466-14-201

Ghiani A, Tsitouras K, Paderewska J, Milger K, Walcher S, Weiffenbach M, et al. Incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning. Ther Adv Chronic Dis 2022; 13. DOI: https://doi.org/10.1177/20406223221109655

https://doi.org/10.1177/20406223221109655 DOI: https://doi.org/10.1177/20406223221109655

Heidler M, Salzwedel A, Jöbges M, Lück O, Dohle C, Seifert M, et al. Decannulation of tracheotomized patients after long-term mechanical ventilation – results of a prospective multicentric study in German neurological early rehabilitation hospitals. BMC Anesthesiol 2018; 18: 65. DOI: https://doi.org/10.1186/s12871-018-0527-3

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Chiavaroli F, Derraik JGB, Zani G, Lavezzi S, Chiavaroli V, Sherwin E, et al. Epidemiology and clinical outcomes in a multicentre regional cohort of patients with severe acquired brain injury. Disabil Rehabil 2016; 38: 2038–2046. DOI: https://doi.org/10.3109/09638288.2015.1111439

https://doi.org/10.3109/09638288.2015.1111439 DOI: https://doi.org/10.3109/09638288.2015.1111439