A standardized decannulation protocol improves outcomes in neurorehabilitation of critically ill patients: a
Liang Zhu1,2, Hong Liu1,2, Na Li1,2
1Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Purpose:
Clinical practice guidelines recommend tracheotomy decannulation protocols for neurorehabilitation of critically ill patients. However, evidence supporting their effectiveness remains limited. This study aimed to analyze the effect of a standardized decannulation protocol on decannulation rates in tracheotomized patients undergoing neurorehabilitation.
Methods:
Participants were recruited from inpatients in the rehabilitation units of a university-affiliated hospital in Sichuan, China. Tracheotomized patients undergoing neurorehabilitation were assigned to the observation and control groups. The observation group received the standardized decannulation protocol (pre-decannulation assessment, training, preparation, decannulation procedure, and post-decannulation monitoring, ATPPM). This protocol is a multidisciplinary rehabilitation bundle based on the principle of optimizing secretion management. The control group received the routine decannulation protocol (pre-protocol) before the implementation of the new protocol. Outcomes included decannulation rates, the interval from capping to decannulation for metallic tracheotomies, tracheotomy duration, length of stay (LOS), and adverse events.
Results:
A total of 466 participants were assigned to the control group (n = 242) and observation group (n = 224). Diagnostic distribution included spinal cord injury (SCI), stroke, and traumatic brain injury (TBI). The age of the control group was 50.59 ± 14.87 years, and that of the observation group was 53.00 ± 15.76 years. The male-to-female ratio of the control group was 2.06:1, and that of the observation group was 3.07:1. The decannulation rate was higher in the ATPPM group than in controls (63/224, 28.12% vs. 49/242, 20.24%, p = 0.047). The ATPPM group had a shorter tracheotomy duration compared with controls (73.5 days vs. 89 days). LOS was significantly reduced in the ATPPM group than in controls (27 days vs. 54 days). An adverse event occurred in one patient (1/224, 0.45%) of the ATPPM group: a tracheotomy tube dislodgement requiring prompt reinsertion.
Conclusion:
Implementation of the ATPPM decannulation protocol in a specialized, hospital-based neurorehabilitation unit significantly improved decannulation outcomes for inpatients with neurological disorders who were medically stable but tracheotomy-dependent. While these retrospective findings are promising, future prospective studies, randomized controlled trials, are essential to confirm efficacy and control for potential confounding variables.
