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Association between Paroxysmal Sympathetic Hyperactivity and tracheostomy weaning in Traumatic Brain Injury.

Hollie Ringrose1,2, Mary Brown1, Krystyna Walton1

  • 1Department of Rehabilitation Medicine (Neurology), Salford Royal Hospital, Salford, UK.

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Summary

Paroxysmal Sympathetic Hyperactivity (PSH) significantly prolongs tracheostomy weaning in severe Traumatic Brain Injury (TBI) patients. This finding aids in setting realistic rehabilitation goals for TBI recovery.

Keywords:
Paroxysmal autonomic instabilitydystoniaintensive careneurorehabilitation

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Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Rehabilitation Medicine

Background:

  • Severe Traumatic Brain Injury (TBI) rehabilitation often necessitates temporary tracheostomies.
  • Tracheostomy weaning is a critical recovery metric influenced by physiological factors.
  • Paroxysmal Sympathetic Hyperactivity (PSH) presents physiological abnormalities impacting TBI patients.

Purpose of the Study:

  • To examine the relationship between PSH and the duration of tracheostomy weaning in patients with severe TBI.
  • To identify if PSH complicates the process of decannulation after TBI.

Main Methods:

  • Retrospective cohort study design.
  • Inclusion of consecutive TBI patients requiring tracheostomy in a Hyper-Acute Neurorehabilitation Unit.
  • Statistical comparison of tracheostomy wean duration between patients with and without PSH.

Main Results:

  • Of 51 TBI patients with tracheostomies, 10 were diagnosed with PSH.
  • The PSH group exhibited a significantly longer mean tracheostomy wean duration (72.3 days) compared to the non-PSH group (30.0 days) (p=0.007).
  • Increased respiratory and oral secretions were noted in the PSH group, though not statistically significant.

Conclusions:

  • This study is the first to establish a significant association between PSH and prolonged tracheostomy weaning in severe TBI.
  • Recognizing this association is crucial for optimizing rehabilitation planning and goal setting for TBI patients.
  • Improved understanding of PSH's impact can lead to more effective tracheostomy management strategies.