Decannulation and improvement of responsiveness in patients with disorders of consciousness

ABSTRACT

Decannulation is a rehabilitation milestone in patients with Disorders of Consciousness (DoC). investigate the relationship between decannulation and improvement of responsiveness (IR) in DoC. 236 tracheostomized patients with severe Acquired Brain Injury and DoC admitted in the Intensive Rehabilitation Unit were retrospectively included. They received personalized interdisciplinary rehabilitation. At discharge, IR was evaluated. The association between IR and demographic/clinical data was investigated using a logistic regression analysis, both in the Unresponsive Wakefulness Syndrome (UWS) and Minimal Consciousness State (MCS) group, divided according to their Coma Recovery Scale-Revised score at admission. In the UWS group (N = 107), only decannulation was associated with IR at discharge (OR: 5.94, CI: 2.08–16.91, p = .001). In the MCS group (N = 129) time post-injury (OR: 0.983, CI: 0.97–0.99, p = .012) and decannulation were associated with IR at discharge (OR: 17.9, CI: 6.39–50.13, p < .001). Decannulation and IR were found to be strongly related, independently from the initial clinical state. While the retrospective nature of the study could not exclude that decannulation may be a consequence of a spontaneous recovery, the obtained results may disclose its potential influence on the clinical history of patients with DoC.

KEYWORDS:

• Decannulation
• Disorders of consciousness
• Tracheostomy
• Rehabilitation
• Severe brain injury

Acknowledgements

The Intensive Rehabilitation Unit Study Group of the IRCCS Don Gnocchi Foundation, Florence, Italy includes: Tiziana Atzori, Barbara Biffi, Marco Borsotti, Maria Chiara Carrozza, Silvia Campagnini, Martina Di Renzone, Irene Galli, Gioele Lastrucci, Elena Lippi, Francesco Lolli, Maria Luisa Luisi, Daniela Maccanti, Andrea Mannini, Anna Mazzucchi, Rinnoci Valentina, Antonello Grippo, Raissa Sterpu, Sandro Sorbi, Federica Vannetti.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by Current Research Funds (2019) from the Ministero della Salute.