Factors associated with tracheostomy decannulation in patients with severe traumatic brain injury

ABSTRACT

Objective

To assess variables associated with decannulation in patients with traumatic brain injury (TBI).

Participants

79 patients with TBI requiring tracheostomy and ICU admission from January 1^st to December 31^st, 2014.

Design

Retrospective analysis.

Measures

Patients decannulated prior to 90 days were compared with patients who remained cannulated. Two Cox Proportional Hazards models were used to predict decannulation using variables prior to tracheostomy and throughout hospitalization.

Results

Median time to decannulation was 37 days (Interquartile Range [IQR] 29–67). Variables prior to tracheostomy associated with decannulation included diabetes (HR, 0.15; 95% CI, 0.03–0.84; p =.03), craniotomy (HR, 0.25; 95% CI, 0.06–1.02; p =.05) and acute kidney injury (AKI) (HR, 0.06; 95% CI, 0.01–0.48; p =.01). Variables present throughout hospitalization included age (HR, 1.12; 95% CI, 1.01–1.21; p =.03), ventilator days (HR, 0.74; 95% CI, 0.57–0.95; p =.02), reintubation (HR, 0.07; 95% CI, 0.01–0.64; p =.02), aspiration (HR, 0.01; 95% CI, 0.0–0.29, p =.01), craniotomy (HR, 0.004; 95% CI, 0.0–0.39; p =.02) and AKI (HR, 0.0; 95% CI, 0.0–0.21; p =.01).

Conclusion

The presence of diabetes, craniotomy and acute kidney injury may inform the conversation surrounding chances for decannulation prior to tracheostomy.

KEYWORDS:

• Tracheostomy
• traumatic Brain Injury
• head Injury
• decannulation

Author disclosure statement

No competing financial interests exist.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Author contributions

N.B., N.M., R.J. contributed to the conception and design of the research. B.H., D.S., G.P., G.S., J.B., N.B., N.M., R.J., R.V.B. W.C., contributed to the acquisition and analysis of data. N.M. and R.J. drafted the article. B.H., D.S., G.P., G.S., J.B., N.B., N.M., R.J., R.V.B, W.C. revised the article critically for important intellectual content. N.M. and R.J. contributed equally to the manuscript.

Industry sponsored

This study is not industry sponsored.