Severe secretion retention: a predictor of decannulation outcome in severe brain injury patients with tracheostomy.
Journal
European journal of physical and rehabilitation medicine
ISSN: 1973-9095
Titre abrégé: Eur J Phys Rehabil Med
Pays: Italy
ID NLM: 101465662
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
medline:
21
4
2023
pubmed:
11
2
2023
entrez:
10
2
2023
Statut:
ppublish
Résumé
Identifying accurate predictors of decannulation outcome is essential to ensure safe and timesaving decannulation. Studies indicated hypopharyngeal secretion retention is closely associated with compromised airway protection and patients with it are less likely to be decannulated. However, data verifying the link between secretion retention and decannulation outcome are lacking. The aim of this study was to identify the association between hypopharyngeal secretion-retention (indicated by Murray Secretion Scale [MSS]) and decannulation outcomes in a large cohort of severe acquired brain injury (sABI) patients with tracheotomy. To test the diagnostic performance of secretion retention in decision making of decannulation. Retrospective cross-sectional study. The setting of the study is neurorehabilitation department in a tertiary teaching hospital. A total of 144 adult patients with sABI and tracheostomy were retrospectively selected from the database from September 1, 2019, to August 31, 2021. The results of hypopharyngeal secretion-retention observed by fiberoptic endoscopy on the day that decision on decannulation was made were collected. The association between severity of secretion retention and decannulation outcomes was investigated through logistic regression, which was used to adjust covariates, including presence of food/liquid aspiration, decreased laryngeal sensation and conscious level. The optimal cut-off values of MSS for decannulation status prediction was determined by maximizing the Youden Index. One hundred twenty-one patients were included in the sample. The age was 55.6±15.2 years, 84 (69.4%) patients were male. Eighty-four (69.4%) of them were successfully decannulated during their hospital stay. Multivariable logistic regression analysis indicated severe secretion retention (MSS level3) was independently associated with prolonged tracheostomy (adjusted odds ratio 65.23, 95% CI 6.58-646.35, P<0.001). The sensitivity and specificity of MSS level3 to assess the probability of prolonged decannulation were 78.4% and 96.4%, respectively. The area under the curve was 0.894 (95% CI 0.819-0.969). Our results add to the evidence supporting screening of secretion retention severity in sABI population to identify patients at risk of prolonged tracheostomy. Whether decreasing secretion retention increases probability of successful decannulation deserves to be investigated by further study. This study could provide evidence for establishing objective decannulation criteria based on fiberoptic endoscopy and be helpful for implementing targeted rehabilitation interventions to promote successful decannulation.
Sections du résumé
BACKGROUND
BACKGROUND
Identifying accurate predictors of decannulation outcome is essential to ensure safe and timesaving decannulation. Studies indicated hypopharyngeal secretion retention is closely associated with compromised airway protection and patients with it are less likely to be decannulated. However, data verifying the link between secretion retention and decannulation outcome are lacking.
AIM
OBJECTIVE
The aim of this study was to identify the association between hypopharyngeal secretion-retention (indicated by Murray Secretion Scale [MSS]) and decannulation outcomes in a large cohort of severe acquired brain injury (sABI) patients with tracheotomy. To test the diagnostic performance of secretion retention in decision making of decannulation.
DESIGN
METHODS
Retrospective cross-sectional study.
SETTING
METHODS
The setting of the study is neurorehabilitation department in a tertiary teaching hospital.
POPULATION
METHODS
A total of 144 adult patients with sABI and tracheostomy were retrospectively selected from the database from September 1, 2019, to August 31, 2021.
METHODS
METHODS
The results of hypopharyngeal secretion-retention observed by fiberoptic endoscopy on the day that decision on decannulation was made were collected. The association between severity of secretion retention and decannulation outcomes was investigated through logistic regression, which was used to adjust covariates, including presence of food/liquid aspiration, decreased laryngeal sensation and conscious level. The optimal cut-off values of MSS for decannulation status prediction was determined by maximizing the Youden Index.
RESULTS
RESULTS
One hundred twenty-one patients were included in the sample. The age was 55.6±15.2 years, 84 (69.4%) patients were male. Eighty-four (69.4%) of them were successfully decannulated during their hospital stay. Multivariable logistic regression analysis indicated severe secretion retention (MSS level3) was independently associated with prolonged tracheostomy (adjusted odds ratio 65.23, 95% CI 6.58-646.35, P<0.001). The sensitivity and specificity of MSS level3 to assess the probability of prolonged decannulation were 78.4% and 96.4%, respectively. The area under the curve was 0.894 (95% CI 0.819-0.969).
CONCLUSIONS
CONCLUSIONS
Our results add to the evidence supporting screening of secretion retention severity in sABI population to identify patients at risk of prolonged tracheostomy. Whether decreasing secretion retention increases probability of successful decannulation deserves to be investigated by further study.
CLINICAL REHABILITATION IMPACT
CONCLUSIONS
This study could provide evidence for establishing objective decannulation criteria based on fiberoptic endoscopy and be helpful for implementing targeted rehabilitation interventions to promote successful decannulation.
Identifiants
pubmed: 36762920
pii: S1973-9087.23.07772-9
doi: 10.23736/S1973-9087.23.07772-9
pmc: PMC10170321
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
174-182Références
Rev Col Bras Cir. 2015 Mar-Apr;42(2):75-80
pubmed: 26176672
Codas. 2019 Dec 02;31(6):e20180228
pubmed: 31800881
Ann Rehabil Med. 2013 Feb;37(1):96-102
pubmed: 23525725
Neurocrit Care. 2019 Jun;30(3):546-554
pubmed: 30919303
Respir Care. 2017 Oct;62(10):1255-1263
pubmed: 28698267
Dysphagia. 2018 Apr;33(2):192-199
pubmed: 28866750
Dysphagia. 1993;8(3):170-9
pubmed: 8359036
Crit Care. 2008;12(1):R26
pubmed: 18302759
Arch Phys Med Rehabil. 2020 Nov;101(11):1906-1913
pubmed: 32428445
Curr Treat Options Neurol. 2014 Jan;16(1):274
pubmed: 24357462
Respir Care. 2022 Jan;67(1):34-39
pubmed: 34344718
Ear Nose Throat J. 2016 Feb;95(2):E7-10
pubmed: 26930346
Dysphagia. 2017 Feb;32(1):27-38
pubmed: 28101663
Dysphagia. 2003 Winter;18(1):32-8
pubmed: 12497194
Dysphagia. 2023 Feb;38(1):42-64
pubmed: 35773497
J Am Med Dir Assoc. 2019 Apr;20(4):470-475.e1
pubmed: 30455047
Neurol Res Pract. 2021 May 10;3(1):26
pubmed: 33966636
Dysphagia. 1996 Spring;11(2):99-103
pubmed: 8721067
Clin Otolaryngol. 2008 Aug;33(4):319-24
pubmed: 18983340
J Stroke Cerebrovasc Dis. 2011 May-Jun;20(3):183-7
pubmed: 20621518
Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2513-2519
pubmed: 28286927
Dysphagia. 2019 Aug;34(4):548-555
pubmed: 30911836
J Appl Oral Sci. 2014 Jul-Aug;22(4):251-60
pubmed: 25141195
BMC Pulm Med. 2018 Oct 11;18(1):159
pubmed: 30305051
Ear Nose Throat J. 2006 Dec;85(12):831-4
pubmed: 17240710
Acta Paediatr. 2007 Mar;96(3):338-41
pubmed: 17407452
Neurology. 2011 Oct 4;77(14):1338-45
pubmed: 21940613
Mov Disord. 2011 Jan;26(1):138-41
pubmed: 21322025
Laryngoscope. 2014 Aug;124(8):1794-800
pubmed: 24473939
Crit Care Med. 2013 Jul;41(7):1728-32
pubmed: 23774336
Am J Speech Lang Pathol. 2017 Aug 15;26(3):729-736
pubmed: 28732098
J Intensive Care. 2017 Jun 20;5:38
pubmed: 28649385
Brain Inj. 2015;29(1):1-10
pubmed: 25313955
Ann Otol Rhinol Laryngol. 2003 May;112(5):469-75
pubmed: 12784989
Clin Exp Dent Res. 2019 Jul 23;5(5):557-565
pubmed: 31687191