Pillai Ijaz N, Chandini Nandyal C, Joseph Smitha, Athani Badarinath, Prasad Deepak J
Department of Physical Medicine and Rehabilitation, St. John's Medical College Hospital.
Division of Epidemiology and Biostatistics, St. John's Research Institute.
Int J Rehabil Res. 2025 Sep 1;48(3):143-148. doi: 10.1097/MRR.0000000000000675. Epub 2025 Jul 7.
Tracheostomy is frequently performed in patients with acquired brain injury (ABI) requiring prolonged ventilatory support. However, prolonged tracheostomy use can impact communication, swallowing, and psychological well-being, making timely decannulation a crucial rehabilitation goal. This study examined the time to decannulation and associated factors in patients with ABI by conducting a retrospective review using medical records of patients with ABI admitted to the Department of Physical Medicine and Rehabilitation (2016-2024). Patients aged ≥18 years, with a tracheostomy tube at admission and who underwent decannulation, were included. The primary outcome was the time to attain decannulation (TAD), with secondary outcomes assessing clinical and functional predictors that may affect TAD. Seventy-seven patients met the inclusion criteria. A total of 77 subjects were included for the analysis, consisting of 19 patients with stroke, 52 patients with traumatic brain injury (TBI), and 6 patients of encephalopathy. The median TAD was 52 days in the overall sample. In simple linear regression, TAD was significantly longer in the stroke than in the TBI subsample (76 vs. 49.5 days, P = 0.019), in younger patients ( P = 0.01), and in those admitted earlier to inpatient rehabilitation ( P < 0.001). In multiple linear regression, younger age, higher Glasgow Coma Scale scores at admission, and earlier inpatient admission were associated with shorter TAD ( P = 0.028, 0.044, <0.001; adjusted R2 = 0.597). The findings of this study may aid in tracheostomy decannulation-related goal setting, patient stratification, managing patient's expectations, and planning appropriate timelines related to tracheostomy decannulation in patients with ABI.
对于需要长期通气支持的获得性脑损伤（ABI）患者，气管切开术经常被实施。然而，长期使用气管切开术会影响沟通、吞咽和心理健康，因此及时拔管成为一个关键的康复目标。本研究通过回顾性分析2016年至2024年在物理医学与康复科住院的ABI患者的病历，研究了ABI患者的拔管时间及相关因素。纳入年龄≥18岁、入院时带有气管切开套管且接受了拔管的患者。主要结局是达到拔管的时间（TAD），次要结局评估可能影响TAD的临床和功能预测因素。77例患者符合纳入标准。共纳入77名受试者进行分析，其中包括19例中风患者、52例创伤性脑损伤（TBI）患者和6例脑病患者。总体样本中TAD的中位数为52天。在简单线性回归中，中风患者的TAD明显长于TBI亚组（76天对49.天，P = 0.019），年轻患者的TAD更长（P = 0.01），以及更早入住住院康复的患者TAD更长（P < 0.001）。在多元线性回归中，年龄较小、入院时格拉斯哥昏迷量表评分较高以及更早入住住院康复与较短的TAD相关（P = 0.028、0.044、<0.001；调整R2 = 0.597）。本研究的结果可能有助于在ABI患者中制定与气管切开术拔管相关的目标、对患者进行分层、管理患者的期望以及规划与气管切开术拔管相关的适当时间安排。
