Decannulation of tracheotomized patients after long-term mechanical ventilation - results of a prospective multicentric study in German neurological early rehabilitation hospitals

BMC Anesthesiol. 2018 Jun 13;18(1):65. doi: 10.1186/s12871-018-0527-3.

Abstract

Background: In the course of neurological early rehabilitation, decannulation is attempted in tracheotomized patients after weaning due to its considerable prognostic significance. We aimed to identify predictors of a successful tracheostomy decannulation.

Methods: From 09/2014 to 03/2016, 831 tracheotomized and weaned patients (65.4 ± 12.9 years, 68% male) were included consecutively in a prospective multicentric observation study. At admission, sociodemographic and clinical data (e.g. relevant neurological and internistic diseases, duration of mechanical ventilation, tracheotomy technique, and nutrition) as well as functional assessments (Coma Recovery Scale-Revised (CRS-R), Early Rehabilitation Barthel Index, Bogenhausener Dysphagia Score) were collected. Complications and the success of the decannulation procedure were documented at discharge.

Results: Four hundred seventy patients (57%) were decannulated. The probability of decannulation was significantly negatively associated with increasing age (OR 0.68 per SD = 12.9 years, p < 0.001), prolonged duration of mechanical ventilation (OR 0.57 per 33.2 days, p < 0.001) and complications. An oral diet (OR 3.80; p < 0.001) and a higher alertness at admission (OR 3.07 per 7.18 CRS-R points; p < 0.001) were positively associated.

Conclusions: This study identified practically measurable predictors of decannulation, which in the future can be used for a decannulation prognosis and supply optimization at admission in the neurological early rehabilitation clinic.

Keywords: Decannulation; Mechanical ventilation; Prognosis; Tracheostomy.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Airway Extubation / adverse effects
  • Airway Extubation / methods*
  • Airway Extubation / trends
  • Device Removal / adverse effects
  • Device Removal / methods
  • Device Removal / trends
  • Female
  • Germany / epidemiology
  • Hospitals, Rehabilitation / methods*
  • Hospitals, Rehabilitation / trends
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / methods*
  • Respiration, Artificial / trends
  • Time Factors
  • Tracheotomy / adverse effects
  • Tracheotomy / methods*
  • Tracheotomy / trends
  • Ventilator Weaning / adverse effects
  • Ventilator Weaning / methods*
  • Ventilator Weaning / trends