Retrospective Analysis of Patients with Immediate Decannulation in Severe Acquired Brain Injury (rapid-sabi)

OBJECTIVE: To examine an early decannulation protocol in adult severe acquired brain injury (SABI) patients.

DESIGN: Retrospective, observational cohort study.

SUBJECTS/PATIENTS: Tracheotomized SABI patients ≥ 18 years admitted to a neurorehabilitation unit.

METHODS: Primary outcome measure was difference in survival rate within first year of discharge. Secondary outcome measures were respiratory infections treated with antibiotics, rate of re-cannulation, time from admission to decannulation, length of stay, difference in rate of re-admission due to pneumonia within first year of discharge and difference in rate of tracheal tube dependency within first year of discharge.

RESULTS: No statistical significance in survival rate within the first 12 months from discharge was found. Median time from admission to decannulation was 32 days (interquartile range [IQR] 14-61) vs 9 days (IQR 0-13) in the control and intervention group, respectively (p < 0.0003). Median length of stay was 66 days (IQR 54-92) in the control group vs 60 (IQR 48-75) days in the intervention group (p = 0.168).

CONCLUSION: A new early decannulation protocol omitting evaluation of tolerance to tracheostomy tube capping and fiberoptic endoscopic evaluation of swallowing was non-inferior to previous procedures in survival rate within first year of discharge. The early decannulation protocol allowed for significantly earlier decannulation.