Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China.
Eur J Phys Rehabil Med. 2023 Apr;59(2):174-182. doi: 10.23736/S1973-9087.23.07772-9. Epub 2023 Feb 10.
Identifying accurate predictors of decannulation outcome is essential to ensure safe and timesaving decannulation. Studies indicated hypopharyngeal secretion retention is closely associated with compromised airway protection and patients with it are less likely to be decannulated. However, data verifying the link between secretion retention and decannulation outcome are lacking.
The aim of this study was to identify the association between hypopharyngeal secretion-retention (indicated by Murray Secretion Scale [MSS]) and decannulation outcomes in a large cohort of severe acquired brain injury (sABI) patients with tracheotomy. To test the diagnostic performance of secretion retention in decision making of decannulation.
Retrospective cross-sectional study.
The setting of the study is neurorehabilitation department in a tertiary teaching hospital.
A total of 144 adult patients with sABI and tracheostomy were retrospectively selected from the database from September 1, 2019, to August 31, 2021.
The results of hypopharyngeal secretion-retention observed by fiberoptic endoscopy on the day that decision on decannulation was made were collected. The association between severity of secretion retention and decannulation outcomes was investigated through logistic regression, which was used to adjust covariates, including presence of food/liquid aspiration, decreased laryngeal sensation and conscious level. The optimal cut-off values of MSS for decannulation status prediction was determined by maximizing the Youden Index.
One hundred twenty-one patients were included in the sample. The age was 55.6±15.2 years, 84 (69.4%) patients were male. Eighty-four (69.4%) of them were successfully decannulated during their hospital stay. Multivariable logistic regression analysis indicated severe secretion retention (MSS level3) was independently associated with prolonged tracheostomy (adjusted odds ratio 65.23, 95% CI 6.58-646.35, P<0.001). The sensitivity and specificity of MSS level3 to assess the probability of prolonged decannulation were 78.4% and 96.4%, respectively. The area under the curve was 0.894 (95% CI 0.819-0.969).
Our results add to the evidence supporting screening of secretion retention severity in sABI population to identify patients at risk of prolonged tracheostomy. Whether decreasing secretion retention increases probability of successful decannulation deserves to be investigated by further study.
This study could provide evidence for establishing objective decannulation criteria based on fiberoptic endoscopy and be helpful for implementing targeted rehabilitation interventions to promote successful decannulation.
准确预测拔管结果对于确保拔管安全和节省时间至关重要。研究表明，咽后分泌物潴留与气道保护受损密切相关，存在该情况的患者不太可能拔管。然而，缺乏证实分泌物潴留与拔管结果之间关联的数据。
本研究旨在确定在接受气管切开术的大量严重获得性脑损伤（sABI）患者中，咽后分泌物潴留（以 Murray 分泌物量表 [MSS] 表示）与拔管结果之间的关联。检测分泌物潴留对拔管决策的诊断性能。
回顾性横断面研究。
研究地点为一家三级教学医院的神经康复科。
从 2019 年 9 月 1 日至 2021 年 8 月 31 日，从数据库中回顾性选择了 144 名患有 sABI 和气管切开术的成年患者。
收集在决定拔管当天通过纤维内镜观察到的咽后分泌物潴留结果。通过逻辑回归调查分泌物潴留严重程度与拔管结果之间的关联，该回归用于调整协变量，包括食物/液体吸入、喉感觉和意识水平下降。通过最大化约登指数确定 MSS 对拔管状态预测的最佳截断值。
在样本中纳入了 121 名患者。年龄为 55.6±15.2 岁，84（69.4%）名患者为男性。其中 84（69.4%）人在住院期间成功拔管。多变量逻辑回归分析表明，严重的分泌物潴留（MSS 3 级）与气管切开术延长独立相关（调整后的优势比 65.23，95%CI 6.58-646.35，P<0.001）。MSS 3 级评估延长拔管可能性的敏感性和特异性分别为 78.4%和 96.4%。曲线下面积为 0.894（95%CI 0.819-0.969）。
我们的结果为支持在 sABI 人群中筛查分泌物潴留严重程度以识别延长气管切开术风险的患者提供了证据。减少分泌物潴留是否会增加成功拔管的可能性，值得进一步研究。
本研究可为基于纤维内镜建立客观的拔管标准提供证据，并有助于实施针对性的康复干预措施，以促进成功拔管。
