Tracheostomy weaning outcomes in relation to the site of acquired brain injury: A retrospective case series.

OBJECTIVE: To analyse whether the outcome of tracheostomy weaning is influenced by the site of injury in acquired brain injury. METHODS: A retrospective case review of all the consecutive admissions to an acute neurorehabilitation unit in a 2-year period was performed. Patients with a diagnosis of acquired brain injury and tracheostomy in situ were included in this study. RESULTS: One hundred and six patients were included in the analysis. They were considered in two groups based on the site of brain injury: Group S, those with supratentorial brain injury only; and Group I, those with any injury with infratentorial involvement. Fifty-one (82%) patients in Group S were successfully weaned from the tracheostomy, compared to only 27 (61%) of patients in Group I. In other words, the proportion of unsuccessful weans (long-term tracheostomy) was 11 (18%) in Group S compared to 17 (39%) in Group I. The statistical significance of successful weans between the groups was p = 0.01 (Chi-square test). The common reasons for unsuccessful weaning were excessive secretion load and recurrent aspiration pneumonia. CONCLUSIONS: Patients with isolated supratentorial brain injury have a statistically significant higher chance of successful decannulation when compared to those patients with any infratentorial brain injury involvement.

Retrospective Analysis of Functional and Tracheostomy (Decannulation) Outcomes in Patients with Brain Injury in a Hyperacute Rehabilitation Unit.

OBJECTIVES: Hyper-Acute Rehabilitation Units (HA-RUs) provide multidisciplinary rehabilitation to patients with acute neurological injuries. This includes managing patients with tracheostomies. This is the first study of its kind to examine clinical outcomes in patients with brain injury and tracheostomy managed in a HARU. METHODS: Retrospective analysis of clinical outcomes in tracheostomy patients admitted to a HARU over a 2-year period. RESULTS: A total of 208 patients were admitted to the HARU, of whom 99 (60 males and 39 females) had a tracheostomy either at admission or during their stay in the HARU. Mean Glasgow Coma Scale score at admission was 11 (range 5-15) and at discharge was 13 (range 8-15). Mean Functional Independence Measure and Functional Assessment Measure (FIM+FAM) score improved from 52 at admission to 95 at discharge. Mean FIM+FAM cognitive admission cognitive sub-score improved from 23 to 42, and mean motor sub-score from 29 to 42. Changes in scores were deemed to be clinically significant as per thresholds reported in the literature. Of the total patients in this study, 79% were successfully decannulated and 21% needed long-term tracheostomy. CONCLUSION: Patients with tracheostomy following brain injury can be appropriately managed in a HARU and show clinically significant improvement in functional outcomes.

Association between Paroxysmal Sympathetic Hyperactivity and tracheostomy weaning in Traumatic Brain Injury.

BACKGROUND: Rehabilitation following severe Traumatic Brain Injury (TBI) often involves the use of temporary tracheostomies. Tracheostomy weaning is influenced by physiological parameters, which are abnormal in the concomitant complication of Paroxysmal Sympathetic Hyperactivity (PSH). OBJECTIVE: To investigate the association between PSH and tracheostomy weaning in severe TBI. METHODS: This was a retrospective cohort study of consecutive patients with TBI and tracheostomy admitted to a Hyper-Acute Neurorehabilitation Unit over a 34-month period. Duration of tracheostomy wean and influencing characteristics were statistically compared between those with and without PSH. RESULTS: Fifty-one patients admitted with TBI required a tracheostomy. Of these, 10 patients were also diagnosed with PSH. The mean tracheostomy wean in the PSH group was longer compared to the non-PSH group (72.3, SD 61.0 versus 30.0 days, SD 16.2). This difference was statistically significant (p = 0.007, using Mann Whitney U test). The PSH group had more respiratory and oral secretions, but this was not statistically significant (p = 0.16 and 0.29). CONCLUSIONS: This is the first study to demonstrate that PSH is associated with prolonged tracheostomy weaning in severe TBI. Awareness of this association should enable those planning rehabilitation to set realistic goals for a patient's tracheostomy weaning programme.