A Pluridisciplinary Tracheostomy Weaning Protocol for Brain-Injured Patients, Outside of the Intensive Care Unit and Without Instrumental Assessment: Results of Pilot Study.

Autor: Gallice T; Neurosurgery Unit B, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France. thomas.gallice@chu-bordeaux.fr.; Bordeaux Research Center for Population Health (BPH), Team: ACTIVE, University Bordeaux Segalen, UMR_S 1219, 33000, Bordeaux, France. thomas.gallice@chu-bordeaux.fr.; Physical and Rehabilitation Medicine Unit, Swallowing Evaluation Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France. thomas.gallice@chu-bordeaux.fr.; Neurological ICU, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France. thomas.gallice@chu-bordeaux.fr., Cugy E; Physical and Rehabilitation Medicine Unit, Swallowing Evaluation Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France.; Arcachon Hospital, Physical and Rehabilitation Medicine Unit, 33260, La Teste de Buch, France., Germain C; Medical Information Unit, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France., Barthélemy C; Neurological ICU, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France., Laimay J; Neurosurgery Unit B, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France.; Neurological ICU, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France., Gaube J; Neurological ICU, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France., Engelhardt M; Physical and Rehabilitation Medicine Unit, Swallowing Evaluation Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France.; Physical and Rehabilitation Medicine Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France.; Physical and Rehabilitation Medicine Unit, Cognition and Language Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France.; Neuro-Vascular Unit, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France., Branchard O; Neurosurgery Unit B, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France., Maloizel E; Neurosurgery Unit B, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France., Frison E; Medical Information Unit, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France., Dehail P; Bordeaux Research Center for Population Health (BPH), Team: ACTIVE, University Bordeaux Segalen, UMR_S 1219, 33000, Bordeaux, France.; Physical and Rehabilitation Medicine Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France., Cuny E; Neurological ICU, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France.; Neurodegenerative Diseases Institute, CNRS, UMR 5293, 33000, Bordeaux, France.
Jazyk: angličtina
Zdroj: Dysphagia [Dysphagia] 2024 Aug; Vol. 39 (4), pp. 608-622. Date of Electronic Publication: 2023 Dec 07.
DOI: 10.1007/s00455-023-10641-7
Abstrakt: Concurrently to the recent development of percutaneous tracheostomy techniques in the intensive care unit (ICU), the amount of tracheostomized brain-injured patients has increased. Despites its advantages, tracheostomy may represent an obstacle to their orientation towards conventional hospitalization or rehabilitation services. To date, there is no recommendation for tracheostomy weaning outside of the ICU. We created a pluridisciplinary tracheostomy weaning protocol relying on standardized criteria but adapted to each patient's characteristics and that does not require instrumental assessment. It was tested in a prospective, single-centre, non-randomized cohort study. Inclusion criteria were age > 18 years, hospitalized for an acquired brain injury (ABI), tracheostomized during an ICU stay, and weaned from mechanical ventilation. The exclusion criterion was severe malnutrition. Decannulation failure was defined as recannulation within 96 h after decannulation. Thirty tracheostomized ABI patients from our neurosurgery department were successively and exhaustively included after ICU discharge. Twenty-six patients were decannulated (decannulation rate, 90%). None of them were recannulated (success rate, 100%). Two patients never reached the decannulation stage. Two patients died during the procedure. Mean tracheostomy weaning duration (inclusion to decannulation) was 7.6 (standard deviation [SD]: 4.6) days and mean total tracheostomy time (insertion to decannulation) was 42.5 (SD: 24.8) days. Our results demonstrate that our protocol might be able to determine without instrumental assessment which patient can be successfully decannulated. Therefore, it may be used safely outside ICU or a specialized unit. Moreover, our tracheostomy weaning duration is very short as compared to the current literature.
(© 2023. The Author(s).)
Databáze: MEDLINE
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