A formalised process for decannulation reduced number of days with tracheostomy for people with an acquired brain injury: a systematic review and meta-analysis
Deborah Mylne
A B * , Nichola Briggs A and Genevieve Tolé B C
A
B
C
Abstract
There is a high incidence of tracheostomy tube placement in patients with acquired brain injury. Due to complex sensory, motor and cognitive presentations, these patients often require long-term tracheostomy tubes, which can result in secondary complications. There is broad variability in tracheostomy management and decannulation decision-making in the literature, with an absence of evidence-based guidelines. The aim of this study was to identify if using a formalised process for decannulation reduced the number of days with tracheostomy for people with an acquired brain injury.
A systematic review of the literature available through MEDLINE, Embase and CINAHL was conducted on 8 August 2022. Studies were eligible if they compared a formalised process for decannulation to usual care reporting outcome measures for total number of days with a tracheostomy. Eligible studies were assessed using the Cochrane risk-of-bias tool (RoB 2). Meta-analysis for primary outcome was completed using a random-effects model.
Five studies met the inclusion criteria, with a total number of 375 participants. Meta-analysis showed that the total number of days with tracheostomy decreased when a formalised process for decannulation was introduced (mean difference −10.66 days, 95% confidence interval [−20.52, −0.81], P = 0.03). All articles were rated high risk of bias as per the RoB 2.
There is evidence that using a formalised process for decannulation reduced the number of days with tracheostomy for people with an acquired brain injury. More rigorous research is required.
PROSPERO, registration number CRD42021252053
Keywords: acquired brain injury, decannulation, meta-analysis, systematic review, tracheostomy.
References
Ancona E, Quarenghi A, Simonini M, Saggini R, Mazzoleni S, De Tanti A, Saviola D, Salvi GP (2019) Effect of verticalization with Erigo® in the acute rehabilitation of severe acquired brain injury. Neurological Sciences 40(10), 2073-2080.
| Crossref | Google Scholar | PubMed |
Bihari S, Prakash S, Hakendorf P, Horwood CM, Tarasenko S, Holt AW, Ratcliffe J, Bersten AD (2018) Healthcare costs and outcomes for patients undergoing tracheostomy in an Australian tertiary level referral hospital. Journal of the Intensive Care Society 19(4), 305-312.
| Crossref | Google Scholar | PubMed |
Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O’Halloran P (2011) Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: cochrane systematic review and meta-analysis. British Medical Journal 342(7790), 214.
| Crossref | Google Scholar |
Boesel J (2013) Tracheostomy in stroke patients. Current Treatment Options in Neurology 16(1), 274.
| Crossref | Google Scholar | PubMed |
Christopher KL (2005) Tracheostomy decannulation. Respiratory Care 50(4), 538-541.
| Google Scholar | PubMed |
Deeks JJ, Higgins JPT, Altman DG (2022) Chapter 10: Analysing data and undertaking meta-analyses. In ‘Cochrane Handbook for Systematic Reviews of Interventions’. (Eds JPT Higgins, J Thomas, J Chandler, M Cumpston, T Li, MJ Page, VA Welch) Available at https://training.cochrane.org/handbook/current/chapter-10#section-10-10
DerSimonian R, Laird N (2015) Meta-analysis in clinical trials revisited. Contemporary Clinical Trials 45(Pt A), 139-145.
| Crossref | Google Scholar | PubMed |
Durbin CG (2010) Tracheostomy: why, when, and how? Respiratory Care 55(8), 1056-1068.
| Google Scholar | PubMed |
Enrichi C, Battel I, Zanetti C, Koch I, Ventura L, Palmer K, Meneghello F, Piccione F, Rossi S, Lazzeri M, Sommariva M, Turolla A (2017) Clinical criteria for tracheostomy decannulation in subjects with acquired brain injury. Respiratory Care 62(10), 1255-1263.
| Crossref | Google Scholar | PubMed |
Frank U, Mäder M, Sticher H (2007) Dysphagic patients with tracheotomies: A multidisciplinary approach to treatment and decannulation management. Dysphagia 22(1), 20-29.
| Crossref | Google Scholar | PubMed |
Garuti G, Reverberi C, Briganti A, Massobrio M, Lombardi F, Lusuardi M (2014) Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols. Multidisciplinary Respiratory Medicine 9(1), 36.
| Crossref | Google Scholar | PubMed |
Gilbert RW, McIlwain JC, Bryce DP, Ross IR (1987) Management of patients with long-term tracheotomies and aspiration. Annals of Otology, Rhinology & Laryngology 96(5), 561-564.
| Crossref | Google Scholar | PubMed |
Gilony D, Gilboa D, Blumstein T, Murad H, Talmi YP, Kronenberg J, Wolf M (2005) Effects of tracheostomy on well-being and body-image perceptions. Otolaryngology - Head and Neck Surgery 133(3), 366-371.
| Crossref | Google Scholar | PubMed |
Gundogdu I, Ozturk EA, Umay E, Karaahmet OZ, Unlu E, Cakci A (2017) Implementation of a respiratory rehabilitation protocol: weaning from the ventilator and tracheostomy in difficult-to-wean patients with spinal cord injury. Disability and Rehabilitation 39(12), 1162-1170.
| Crossref | Google Scholar | PubMed |
Hakiki B, Donnini I, Romoli AM, Draghi F, Maccanti D, Grippo A, Scarpino M, Maiorelli A, Sterpu R, Atzori T, Mannini A, Campagnini S, Bagnoli S, Ingannato A, Nacmias B, De Bellis F, Estraneo A, Carli V, Pasqualone E, et al. (2022) Clinical, neurophysiological, and genetic predictors of recovery in patients with severe acquired brain injuries (PRABI): a study protocol for a longitudinal observational study. Frontiers in Neurology 13, 711312.
| Crossref | Google Scholar | PubMed |
Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC (2022) Chapter 8: Assessing risk of bias in a randomized trial. In ‘Cochrane Handbook for Systematic Reviews of Interventions’. (Eds JPT Higgins, J Thomas, J Chandler, M Cumpston, T Li, MJ Page, VA Welch) Available at https://training.cochrane.org/handbook/current/chapter-08#section-8-2
Krishnamoorthy V, Hough CL, Vavilala MS, Komisarow J, Chaikittisilpa N, Lele AV, Raghunathan K, Creutzfeldt CJ (2019) Tracheostomy after severe acute brain injury: trends and variability in the USA. Neurocritical Care 30(3), 546-554.
| Crossref | Google Scholar | PubMed |
Law JH, Barnhart K, Rowlett W, de la Rocha O, Lowenberg S (1993) Increased frequency of obstructive airway abnormalities with long-term tracheostomy. Chest 104(1), 136-138.
| Crossref | Google Scholar | PubMed |
LeBlanc J, Shultz JR, Seresova A, De Guise E, Lamoureux J, Fong N, Marcoux J, Maleki M, Khwaja K (2010) Outcome in tracheostomized patients with severe traumatic brain injury following implementation of a specialized multidisciplinary tracheostomy team. The Journal of Head Trauma Rehabilitation 25(5), 362-365.
| Crossref | Google Scholar | PubMed |
Michelutti A, D’Angelo M, Szulin M, Stroppolo G, Bargellesi S, Giorgini T, Quattrin R, Biasutti E (2021) The tracheotomy tube weaning in patients with severe acquired brain injury: comparison of two operative procedures in a postacute rehabilitation hospital. European Journal of Physical and Rehabilitation Medicine 57(3), 347-355.
| Crossref | Google Scholar | PubMed |
Mussa CC, Gomaa D, Rowley DD, Schmidt U, Ginier E, Strickland SL (2021) AARC clinical practice guideline: management of adult patients with tracheostomy in the acute care setting. Respiratory Care 66(1), 156-169.
| Crossref | Google Scholar | PubMed |
O’Connor HH, White AC (2010) Tracheostomy Decannulation. Respiratory Care 55(8), 1076-1081.
| Google Scholar | PubMed |
Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, et al. (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. British Medical Journal 372, n160.
| Crossref | Google Scholar | PubMed |
Pandian V, Miller CR, Schiavi AJ, Yarmus L, Contractor A, Haut ER, Feller-Kopman DJ, Mirski MA, Morad AH, Carey JP, Hillel AT, Maragos CS, Bhatti NI (2014) Utilization of a standardized tracheostomy capping and decannulation protocol to improve patient safety. The Laryngoscope 124(8), 1794-1800.
| Crossref | Google Scholar | PubMed |
Pelosi P, Ferguson ND, Frutos-Vivar F, Anzueto A, Putensen C, Raymondos K, Apezteguia C, Desmery P, Hurtado J, Abroug F, Elizalde J, Tomicic V, Cakar N, Gonzalez M, Arabi Y, Moreno R, Esteban A, Ventila Study Group (2011) Management and outcome of mechanically ventilated neurologic patients. Critical Care Medicine 39(6), 1482-1492.
| Crossref | Google Scholar | PubMed |
Perin C, Meroni R, Rega V, Braghetto G, Cerri CG (2017) Parameters influencing tracheostomy decannulation in patients undergoing rehabilitation after severe acquired brain injury (sABI. International Archives of Otorhinolaryngology 21(4), 382-389.
| Crossref | Google Scholar | PubMed |
Riley RD, Higgins JPT, Deeks JJ (2011) Interpretation of random effects meta-analyses. British Medical Journal 342, d549.
| Crossref | Google Scholar | PubMed |
Santus P, Gramegna A, Radovanovic D, Raccanelli R, Valenti V, Rabbiosi D, Vitacca M, Nava S (2014) A systematic review on tracheostomy decannulation: a proposal of a quantitative semiquantitative clinical score. BMC Pulmonary Medicine 14(1), 201.
| Crossref | Google Scholar | PubMed |
Singh RK, Saran S, Baronia AK (2017) The practice of tracheostomy decannulation-a systematic review. Journal of Intensive Care 5(1), 38.
| Crossref | Google Scholar | PubMed |
Speed L, Harding KE (2013) Tracheostomy teams reduce total tracheostomy time and increase speaking valve use: a systematic review and meta-analysis. Journal of Critical Care 28(2), 216.e1-216.e10.
| Crossref | Google Scholar | PubMed |
Stelfox HT, Crimi C, Berra L, Noto A, Schmidt U, Bigatello LM, Hess D (2008) Determinants of tracheostomy decannulation: an international survey. Critical Care 12(1), R26.
| Crossref | Google Scholar | PubMed |
Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Medical Research Methodology 14(1), 135.
| Crossref | Google Scholar |
Zanata IL, Santos RS, Marques JM, Hirata GC, Santos DA (2016) Speech-language pathology assessment for tracheal decannulation in patients suffering from traumatic brain injury. Communication Disorders, Audiology and Swallowing 28(6), 710-716.
| Crossref | Google Scholar | PubMed |
Zhou T, Wang J, Zhang C, Zhang B, Guo H, Yang B, Li Q, Ge J, Li Y, Niu G, Gao H, Jiang H (2022) Tracheostomy decannulation protocol in patients with prolonged tracheostomy referred to a rehabilitation hospital: a prospective cohort study. Journal of Intensive Care 10(1), 34.
| Crossref | Google Scholar | PubMed |
Zivi I, Valsecchi R, Maestri R, Maffia S, Zarucchi A, Molatore K, Vellati E, Saltuari L, Frazzitta G (2018) Early rehabilitation reduces time to decannulation in patients with severe acquired brain injury: a retrospective study. Frontiers in Neurology 9, 559.
| Crossref | Google Scholar | PubMed |
