# A standardized decannulation protocol improves outcomes in neurorehabilitation of critically ill patients: a quasi-experimental pre-post design

## TL;DR

A new standardized protocol for removing tracheotomy tubes improved success rates and reduced hospital stays for critically ill patients in neurorehabilitation.

## Contribution

The study introduces and validates a multidisciplinary decannulation protocol (ATPPM) for neurorehabilitation patients.

## Key findings

- The ATPPM group had a higher decannulation rate (28.12%) compared to the control group (20.24%).
- ATPPM reduced tracheotomy duration by 15.5 days and hospital length of stay by 27 days.
- Only one adverse event (0.45%) occurred in the ATPPM group.

## Abstract

Clinical practice guidelines recommend tracheotomy decannulation protocols for neurorehabilitation of critically ill patients. However, evidence supporting their effectiveness remains limited. This study aimed to analyze the effect of a standardized decannulation protocol on decannulation rates in tracheotomized patients undergoing neurorehabilitation.

Participants were recruited from inpatients in the rehabilitation units of a university-affiliated hospital in Sichuan, China. Tracheotomized patients undergoing neurorehabilitation were assigned to the observation and control groups. The observation group received the standardized decannulation protocol (pre-decannulation assessment, training, preparation, decannulation procedure, and post-decannulation monitoring, ATPPM). This protocol is a multidisciplinary rehabilitation bundle based on the principle of optimizing secretion management. The control group received the routine decannulation protocol (pre-protocol) before the implementation of the new protocol. Outcomes included decannulation rates, the interval from capping to decannulation for metallic tracheotomies, tracheotomy duration, length of stay (LOS), and adverse events.

A total of 466 participants were assigned to the control group (n = 242) and observation group (n = 224). Diagnostic distribution included spinal cord injury (SCI), stroke, and traumatic brain injury (TBI). The age of the control group was 50.59 ± 14.87 years, and that of the observation group was 53.00 ± 15.76 years. The male-to-female ratio of the control group was 2.06:1, and that of the observation group was 3.07:1. The decannulation rate was higher in the ATPPM group than in controls (63/224, 28.12% vs. 49/242, 20.24%, p = 0.047). The ATPPM group had a shorter tracheotomy duration compared with controls (73.5 days vs. 89 days). LOS was significantly reduced in the ATPPM group than in controls (27 days vs. 54 days). An adverse event occurred in one patient (1/224, 0.45%) of the ATPPM group: a tracheotomy tube dislodgement requiring prompt reinsertion.

Implementation of the ATPPM decannulation protocol in a specialized, hospital-based neurorehabilitation unit significantly improved decannulation outcomes for inpatients with neurological disorders who were medically stable but tracheotomy-dependent. While these retrospective findings are promising, future prospective studies, randomized controlled trials, are essential to confirm efficacy and control for potential confounding variables.