RETROSPECTIVE ANALYSIS OF PATIENTS WITH IMMEDIATE DECANNULATION IN SEVERE ACQUIRED BRAIN INJURY (RAPID-SABI)

TL;DR

A new protocol for early tracheostomy removal in severe brain injury patients was found to be safe and allowed for earlier decannulation without increasing mortality.

Contribution

A new early decannulation protocol was shown to be non-inferior in survival rate while allowing earlier tracheostomy removal.

Findings

The new protocol allowed significantly earlier decannulation (median 9 days vs 32 days).

No significant difference in survival rate within the first year of discharge was observed.

A trend toward shorter length of stay in the neurorehabilitation unit was noted in the intervention group.

Abstract

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

Retrospective, observational cohort study.

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

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.

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).

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.

This study aimed to examine what the influence of earlier removal of a tracheostomy is on the mortality within the first year after discharge in patients with severe acquired brain injury. One group of 27 patients that was treated under the new protocol was compared to a group of 34 patients that was treated with the previous protocol. All adult patients admitted to our neurorehabilitation unit with a tracheostomy were included. Our results showed that the new protocol did not increase the risk of mortality within the first year of discharge from our unit. However, the tracheostomy could be removed earlier in patients treated under the new protocol. Moreover, our study showed a tendency to a shorter stay in our neurorehabilitation unit for patients who were treated with earlier removal of tracheostomy. The new protocol should be investigated in prospective studies to confirm our findings.

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