ArticleFrontiers in neurology
A stepwise decannulation pathway for patients with prolonged disorders of consciousness after brain injury: a retrospective feasibility study.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Structured tracheostomy decannulation pathways specifically tailored to patients with prolonged disorders of consciousness (pDoC) after brain injury remain limited. We aimed to describe a stepwise decannulation pathway and evaluate its feasibility and safety in this population. Methods: We retrospectively reviewed consecutive tracheostomized patients with pDoC after brain injury admitted to a single rehabilitation center. The pathway integrated flexible laryngoscopy for assessment of airway patency and secretion burden using the Murray Secretion Scale (MSS), assessment of airway protection using the Semi-quantitative Cough Strength Score (SCSS), and a monitored 48-h capping trial. The primary outcomes were feasibility (decannulation rate), early safety (reintubation or transfer to the ICU within 48 h), and short-term safety (reintubation within 3 months). Secondary outcomes included time from referral to decannulation, airway findings, and MSS grades on flexible laryngoscopy, SCSS score, and reasons for non-decannulation. Results: Among 61 included patients, 35 (57.4%) were successfully decannulated. No patient required reintubation or transfer to the ICU within 48 h after decannulation. One patient underwent reintubation approximately 1 month later because of severe liver failure rather than airway compromise. The mean time to decannulation was 19.8 ± 8.2 days. Airway lesions were identified in 54 patients (88.5%), and 31 (50.8%) had MSS ≥ 2. Twelve patients (19.7%) had SCSS < 3. The main barriers to decannulation were airway stenosis ≥50%, uncontrolled secretion burden, inadequate cough-mediated airway protection, and worsening pulmonary infection during capping. Conclusion: In this single-center retrospective study, the stepwise decannulation pathway appeared feasible and was associated with favorable short-term safety outcomes in patients with pDoC after brain injury. The pathway may provide a structured framework for decannulation decision-making in this population. Further prospective, multicenter studies are needed to validate these findings.
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