A Pluridisciplinary Tracheostomy Weaning Protocol for Brain-Injured Patients, Outside of the Intensive Care Unit and Without Instrumental Assessment: Results of Pilot Study.
Thomas Gallice, Emmanuelle Cugy, Christine Germain and 9 others
PMID 38062168WHAT IT FOUND
In 30 tracheostomized brain-injured patients, a ward-based clinical weaning protocol removed the tube in 26, and all removals were successful.
This pilot suggests non-ICU decannulation may be feasible, but it needs a controlled trial.
Key findings
01Of 30 included patients, 26 were decannulated, and all decannulations were successful.
02The mean tracheostomy weaning duration was 7.6 days, and the mean total tracheostomy time was 42.5 days.
03At 6 months, 27 patients were alive, and none of the 26 decannulated patients had been recannulated.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for SLPs
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What it does not show
The study had no control group, randomisation, or blinding, so it cannot show that the protocol worked better than usual care. It included only 30 patients at one hospital, so the results may reflect local team experience and resources. The protocol was not tested against a FEES-guided or VFSS-guided protocol. Swallowing was assessed clinically, and alimentary swallowing was not tested during weaning, so aspiration or dysphagia could have been missed. Two patients died during weaning, and imputability to the protocol could not be excluded for one patient. Patients were included only after ICU discharge and had late weaning, so it may not apply to earlier ICU weaning. Nurses and paramedical staff were trained specifically for the protocol, so results may not transfer to units without similar training and supervision.
Declared interests
The only funding statement names the Centre Hospitalier Universitaire de Bordeaux.
The easy way to misread this
Do not read the 100% decannulation success as proof the protocol is safe or better than FEES-guided care. It was a 30-patient single-arm pilot, two patients died before decannulation, and the authors say it needs testing against a FEES-guided protocol.