Decannulation Timing is an Expression of Neurological Recovery Time: The Need to Define a Performance within a Time Frame

Abstract

Introduction: The factors that influence the likelihood of tracheostomy tube weaning in patients with severe acquired brain injury (sABI) are fairly well known, and recently it has been pointed out that improving swallowing and cough resistance are among the most important. What has not yet been focused on is the “passage of time” factor and how much it affects weaning opportunities. Objective: With this study, we wanted to analyze how the probability of decannulation varies over time, consistent with neurological improvement. Method: We examined the tracheostomy database of our neurological rehabilitation unit, which reports data from 359 patients with sABI, hospitalized between 2000 and 2012, and all carriers of tracheostomy tube upon admission. The sample was divided into two groups based on the time gap between the acute event and admission to rehabilitation, an Early Group = 60 days and a Late Group > 60 days. The probability of decannulation, both overall and subdivided by groups, was then evaluated. Results: The E-Group showed better functional scores at discharge and a better percentage of decannulation compared with the L-Group. The differences were statistically significant, but later decannulations were not unusual: 12% late weanings versus 88% earlier. The probability of decannulation increases over time and is a factor dependent on the degree of neurological and functional recovery. It is of primary importance to consider these aspects when making comparisons between different centers, defining a product standard or performing benchmarking analyses. Conclusions: The rehabilitative prognosis for decannulation can be reliably judged only after a suitable and well-defined period of time, because the probability of tube weaning has been shown to be strongly dependent on the amount of time that passes. This study also showed that effective decannulations can be achieved even more than 6 months after the acute event, although with significantly lower probabilities.