RETROSPECTIVE ANALYSIS OF PATIENTS WITH IMMEDIATE DECANNULATION IN SEVERE ACQUIRED BRAIN INJURY (RAPID-SABI)

Area of Science:

• Neuroscience
• Critical Care Medicine
• Otolaryngology

Background:

• Severe acquired brain injury (SABI) often necessitates tracheostomy, leading to prolonged airway management.
• Early decannulation protocols aim to expedite the removal of tracheostomy tubes, potentially improving patient outcomes.
• Current protocols may involve extensive evaluations, delaying decannulation.

Purpose of the Study:

• To evaluate the safety and efficacy of a novel early decannulation protocol in adult SABI patients.
• To compare survival rates and other key outcomes between patients managed with the early decannulation protocol and a control group.

Main Methods:

• Retrospective, observational cohort study of tracheotomized SABI patients (≥ 18 years) admitted to a neurorehabilitation unit.
• Primary outcome: 1-year post-discharge survival rate.
• Secondary outcomes: Respiratory infections, re-cannulation, time to decannulation, length of stay, re-admission rates, and tracheal tube dependency.

Main Results:

• No significant difference in 1-year survival rates between the early decannulation group and the control group.
• Median time to decannulation was significantly shorter in the early decannulation group (9 days vs. 32 days, p < 0.0003).
• No significant difference in length of stay (60 days vs. 66 days, p = 0.168).

Conclusions:

• The new early decannulation protocol is non-inferior to previous methods regarding 1-year survival.
• This protocol facilitates significantly earlier decannulation in SABI patients.
• The protocol omits specific evaluations, streamlining the decannulation process.