[Impact of severe laryngotracheal injuries on decannulation failure in adult patients. Retrospective cohort]

Introduction: Chronically critically ill patients may require tracheostomy due to the need for prolonged mechanical ventilation, which could increase the risk of laryngotracheal injuries. The aim of the study was to evaluate whether tracheostomized patients with severe laryngotracheal injuries have a higher rate of decannulation failure. Materials and method: A retrospective cohort study was conducted at Clínica Basilea. Adult patients requiring a tracheostomy cannula, weaned from invasive mechanical ventilation and who had undergone flexible fiberoptic bronchoscopy were included. Results: During the study period analyzed 622 patients were admitted to the center. 69.29% (n=431) presented airway pathologies, of which 72.62% (n=313) were mild injuries and 27.38% (n=118) were severe. Patients with severe injuries had a lower decannulation rate of 27.12% (n=32) and a higher recannulation rate of 5.93% (n=7) compared to patients with normal airway and mild injuries. The most frequent pathology was granulomas in 59.34% (n=324), followed by dynamic airway collapse in 34.06% (n=186) and stenosis in 6.59% (n=36). Conclusion: Adult tracheostomized patients with severe laryngotracheal injuries were decannulated less and had a greater need for recannulation compared to those with normal airway and mild injuries. The incidence of decannulation failure in patients with normal airway was 2.09% and in those with mild and severe injuries was 2.55% and 5.93%, respectively.