Tracheostomy Decannulation and Disorders of Consciousness Evolution.

Area of Science:

• Neurology
• Surgical Procedures
• Rehabilitation Medicine

Background:

• Tracheostomy is common in patients with chronic disorders of consciousness (DOC).
• There is no established consensus on the safety of tracheostomy decannulation for this patient group.
• This study investigates predictors for tracheostomy decannulation in DOC patients.

Purpose of the Study:

• To determine if improvement in disorders of consciousness (DOC) predicts successful tracheostomy decannulation.
• To analyze secondary outcomes including mortality rate and discharge destination.

Main Methods:

• An observational, retrospective case-control study was conducted at a weaning and rehabilitation center.
• Tracheostomized patients with DOC admitted between August 2015 and December 2017 were included.
• Patients were matched based on Coma Recovery Scale-Revised (CRS-R) scores; improved DOC patients were cases, while those remaining tracheostomized were controls.

Main Results:

• In a cohort of 44 patients (22 per group), improved DOC significantly predicted decannulation (OR 11.28).
• Decannulation was less likely in patients not improving from a vegetative state (VS) (OR 0.13).
• Notably, 8 VS patients were decannulated with no deaths, while controls had higher mortality (P = .02).

Conclusions:

• Improvement in disorders of consciousness is a key predictor for successful tracheostomy decannulation.
• Tracheostomy decannulation is feasible in some vegetative state patients, associated with reduced mortality.
• Further research can refine decannulation protocols for DOC patients.