Rehabilitative intervention for successful decannulation in adult patients with acquired brain injury and tracheostomy: a systematic review

Abstract

Purpose

Tracheostomy and dysphagia are independently associated with increased complications and poorer functional outcome after acquired brain injury (ABI). The aim of this study was to identify and evaluate rehabilitation to restore functional swallowing ability and respiratory capacity during tracheal tube weaning.

Materials and methods

The review was conducted according to PRISMA guidelines. Any study design with adult patients with ABI and tracheostomy was eligible. The primary outcome was decannulation.

Results

A total of 2647 records were identified and eight papers included. Four studies investigated pharyngeal electrical stimulation (PES), two explored Facial Oral Tract Therapy (F.O.T.T.), one respiratory physiotherapy (RPT), and one study investigated external subglottic air flow (ESAF). Two RCTs found a significant difference between intervention and control on successful decannulation and readiness for decannulation in favour of PES. Time from rehabilitation admission and tracheostomy to decannulation was significantly reduced after implementing an F.O.T.T.-based protocol.

Conclusion

Four interventions were identified, PES, F.O.T.T., RPT, and ESAF, all aimed at increasing oropharyngeal sensory input through stimulation. Due to heterogeneity of interventions, designs and outcome measures, effect could not be estimated. This review highlights the limited research on rehabilitative interventions and thus the limited evidence to guide clinical rehabilitation.

IMPLICATIONS FOR REHABILITATION

Rehabilitation for early decannulation after brain injury

• Dysphagia and tracheostomy often coexist in neurocritical care and early rehabilitation.

• Four rehabilitative interventions were identified—pharyngeal electrical stimulation, external subglottic airflow, respiratory physiotherapy and facial-oral tract therapy.

• Interventions points to a consensus that sensory stimulation of the oropharynx can increase excitability of the swallowing network and support pharyngeal sensorimotor cortex reorganisation.

• This review highlights the limited research on therapeutic rehabilitative interventions and thus the limited evidence to guide clinical rehabilitation.

Keywords:

• Rehabilitation
• weaning
• brain injury
• tracheostomy
• decannulation
• systematic review

Acknowledgements

The authors would like to thank health science librarian Karine Korsgaard for her contribution in the development and evaluation of the search strategy. We would also like to acknowledge the Danish Victim Fund and the Occupational Therapy Foundation’s Research fund for grants to support this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data generated or analysed in this review is included in this article. Further inquiries are welcome and can be directed to the corresponding author.

Additional information

Funding

This study has received financial support from the Danish Victim Fund and the Occupational Therapy Foundation’s Research fund.