Tracheostomy Decannulation and Disorders of Consciousness Evolution.

Autor:	Bellon PA; Santa Catalina Neurorehabilitación Clínica, Buenos Aires City, Argentina and Hospital General de Agudos Dr. I. Pirovano, Buenos Aires City, Argentina. pabloabellon@gmail.com., Bosso MJ; Santa Catalina Neurorehabilitación Clínica, Buenos Aires City, Argentina and Hospital General de Agudos Dr. I. Pirovano, Buenos Aires City, Argentina., Echegaray JEC; Santa Catalina Neurorehabilitación Clínica, Buenos Aires City, Argentina and Hospital Universitario UAI, Buenos Aires City, Argentina., Larocca F; Santa Catalina Neurorehabilitación Clínica, Buenos Aires City, Argentina and Hospital Naval Buenos Aires, Buenos Aires City, Argentina., Gagliardi J; Santa Catalina Neurorehabilitación Clínica, Buenos Aires City, Argentina., Primosich WA; Santa Catalina Neurorehabilitación Clínica, Buenos Aires City, Argentina and Hospital General de Agudos Dr. I. Pirovano, Buenos Aires City, Argentina., Pavón HM; Santa Catalina Neurorehabilitación Clínica, Buenos Aires City, Argentina and Hospital Alemán, Buenos Aires City, Argentina., Yorio RD; Santa Catalina Neurorehabilitación Clínica, Buenos Aires City, Argentina; and Sanatorio Finochietto, Buenos Aires City, Argentina., Cancino JJ; Santa Catalina Neurorehabilitación Clínica, Buenos Aires City, Argentina and Hospital Alemán, Buenos Aires City, Argentina.
Jazyk:	angličtina
Zdroj:	Respiratory care [Respir Care] 2022 Feb; Vol. 67 (2), pp. 209-215. Date of Electronic Publication: 2021 Nov 30.
DOI:	10.4187/respcare.08301
Abstrakt:	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. (Copyright © 2022 by Daedalus Enterprises.)
Databáze:	MEDLINE
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