Decannulation patterns and predictors in acquired brain injury: a retrospective study

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.