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- Title
Factors influencing delayed tracheostomy weaning in acquired brain injury: A retrospective case series.
- Authors
Mitton, K.; Walton, K.; Sivan, M.
- Abstract
Aim: To analyse factors that influence (a) delaying tracheostomy weaning and (b) the requirement of long term tracheostomy in patients following an acquired brain injury. Method: A retrospective case review was performed of all consecutive admissions to a hyperacute neurorehabilitation unit in a two-year period. Patients with a diagnosis of acquired brain injury and tracheostomy in situ were included for this study. Data was collected from the weekly MDT tracheostomy ward round for the duration of stay. This included tracheostomy weaning milestones and factors that influenced a delay in weaning plans. Results: A total of 106 patients were included in the analysis. There were 65 males and 41 females with a mean age of 52 (SD 16). The diagnosis was 56% non-traumatic brain injury and 44% traumatic brain injury. The mean GCS on admission was 11 and discharge was 12. A total of 74% (n = 78) of patients were successfully weaned from the tracheostomy within an average of 59 days from tracheostomy insertion. The number of unsuccessful weans (long term tracheostomy) was 26% (n = 28) with an average of 201 days for this decision to be made by the MDT. The 26 factors identified as delaying the weaning process were classified into six categories: Secretion management (37% of all reported factors), medical instability – infective (34%), medical instability – non-infective (15%), postural management (6%), tracheostomy management (5%), and oropharyngeal anatomy (3%). The three most commonly reported factors were oropharyngeal secretion management 46% (n = 49), respiratory infection 42% (n = 45), and respiratory secretion management 38% (n = 40). Eleven reasons were attributed to the need or outcome of a long-term tracheostomy, the most common being; 43% (n = 12) owing to an excessive secretion load, 18% (n = 5) owing to recurrent aspiration pneumonia. A total of 17% (n = 19) of all patients had paroxysmal sympathetic hyperactivity with 36% (n = 7) of this group requiring a long-term tracheostomy owing to excessive secretion load. Conclusion: The common factors that delay tracheostomy weaning are oropharyngeal secretion management, respiratory infection, and respiratory secretion management. The most common reasons for unsuccessful weaning were excessive secretion load and recurrent aspiration pneumonia.
- Publication
Clinical Rehabilitation, 2017, Vol 31, Issue 6, p848
- ISSN
0269-2155
- Publication type
Article
- DOI
10.1177/0269215517698029