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Abstract
BACKGROUND: Tracheostomy is a frequent surgical procedure in subjects with chronic disorders of consciousness (DOC). There is no consensus about safety of tracheostomy decannulation in this population.The aim of our study was to estimate if DOC improvement is a predictor for tracheostomy decannulation. Secondary outcomes include mortality rate and discharge destination.
METHODS: We conducted an observational, retrospective, case-control study at a weaning and rehabilitation center (WRC). We included tracheostomized subjects with DOC admitted between August 2015 and December 2017. We matched groups based on the consciousness level at admission assessed withthe coma recovery scale revised (CRS-R). Subjects who were later decannulated formed the cases, while those that remained tracheostomized at the end of follow-up formed the controls. Improvement of DOC was defined as a progress in the categories of the CRS-R.
RESULTS: 22 subjects were included in each group. No significant differences were found in clinical and demographic variables, except that controls had longer neurologic injury evolution (65.5 vs 51 days, P = .047), more tracheostomy days at admission to ourinstitution (53 vs 33.5, P = .02), and higher prevalence of neurological comorbidities (12 vs 4, P = .03). Subjects who improved their DOC had more chances of being decannulated (OR 11.28, 95% CI 1.96–123.08). Tracheostomy decannulation could not be achieved in most subjects who did not improve from vegetative state (VS) (OR 0.13, 95% CI 0.02–0.60). 8 subjects, however, could be decannulated in VS, with only one decannulation failure and no deaths. Mortality was higher in controls (0 vs 6, P = .02), especially among VS (0 vs 5, P = .049). No significant differences were found in discharge destination between groups.
CONCLUSIONS: Subjects who improve their DOC are more likely to achieve tracheostomy decannulation. Some subjects in VS were decannulated, with lower mortality than those who remained tracheostomized.
- tracheostomy
- decannulation
- consciousness disorders
- persistent vegetative state
- chronic brain injury
- rehabilitation centers
Footnotes
- Correspondence: Pablo Antonio Bellon RRT, Santa Catalina Neurorehabilitación Clínica, Department of Respiratory Care, Catamarca 934, C1231AAJ, Ciudad Autónoma de Buenos Aires, Argentina. E-mail: pabloabellon{at}gmail.com
The authors have disclosed no conflicts of interest.
A version of this paper was presented by Mr Bellon at the 47th Congreso Argentino de Medicina Respiratoria, held in Rosario, Santa Fe, Argentina, October 31–November 3, 2019.
The study was performed at Santa Catalina Neurorehabilitación Clínica, Buenos Aires City, Argentina.
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