A Pluridisciplinary Tracheostomy Weaning Protocol for Brain-Injured Patients, Outside of the Intensive Care Unit and Without Instrumental Assessment: Results of Pilot Study.
Acquired brain injury
Decannulation
Post intensive care unit
Rehabilitation
Tracheostomy weaning
Journal
Dysphagia
ISSN: 1432-0460
Titre abrégé: Dysphagia
Pays: United States
ID NLM: 8610856
Informations de publication
Date de publication:
07 Dec 2023
07 Dec 2023
Historique:
received:
29
09
2022
accepted:
06
11
2023
medline:
8
12
2023
pubmed:
8
12
2023
entrez:
7
12
2023
Statut:
aheadofprint
Résumé
Concurrently to the recent development of percutaneous tracheostomy techniques in the intensive care unit (ICU), the amount of tracheostomized brain-injured patients has increased. Despites its advantages, tracheostomy may represent an obstacle to their orientation towards conventional hospitalization or rehabilitation services. To date, there is no recommendation for tracheostomy weaning outside of the ICU. We created a pluridisciplinary tracheostomy weaning protocol relying on standardized criteria but adapted to each patient's characteristics and that does not require instrumental assessment. It was tested in a prospective, single-centre, non-randomized cohort study. Inclusion criteria were age > 18 years, hospitalized for an acquired brain injury (ABI), tracheostomized during an ICU stay, and weaned from mechanical ventilation. The exclusion criterion was severe malnutrition. Decannulation failure was defined as recannulation within 96 h after decannulation. Thirty tracheostomized ABI patients from our neurosurgery department were successively and exhaustively included after ICU discharge. Twenty-six patients were decannulated (decannulation rate, 90%). None of them were recannulated (success rate, 100%). Two patients never reached the decannulation stage. Two patients died during the procedure. Mean tracheostomy weaning duration (inclusion to decannulation) was 7.6 (standard deviation [SD]: 4.6) days and mean total tracheostomy time (insertion to decannulation) was 42.5 (SD: 24.8) days. Our results demonstrate that our protocol might be able to determine without instrumental assessment which patient can be successfully decannulated. Therefore, it may be used safely outside ICU or a specialized unit. Moreover, our tracheostomy weaning duration is very short as compared to the current literature.
Identifiants
pubmed: 38062168
doi: 10.1007/s00455-023-10641-7
pii: 10.1007/s00455-023-10641-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Centre Hospitalier Universitaire de Bordeaux
ID : CHUBX 2017/31
Informations de copyright
© 2023. The Author(s).
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