PDF(Pubmed)
Abstract：
BACKGROUND: Prolonged tracheal tube placement following severe traumatic brain injury (TBI) can cause serious complications. Safe removal requires sufficient ability for independent breathing and airway protection. Thus, identifying important factors for time to removal of the tracheal tube (decannulation) is essential for safe and efficient weaning. This study aimed to identify significant factors for time to decannulation in a Danish population of subjects with tracheostomy after TBI.
METHODS: This was a retrospective register-based cohort study. Subjects with moderate and severe TBI and a tracheal tube were selected from the Danish Head Trauma Database between 2011-2021. Time to decannulation was calculated as time from injury to decannulation. Associations between selected explanatory variables representing demographic and clinical characteristics and time to decannulation were analyzed using linear regression models.
RESULTS: A total 324 subjects were included with a median of 44 d to decannulation. Primary analysis found that an improvement in swallowing ability during the initial 4 weeks of rehabilitation was associated with an 8.2 d reduction in time to decannulation (95% CI -12.3 to -4.2, P < .001). Change in overall sensorimotor ability reduced time to decannulation by 0.94 (95% CI -0.78 to -0.10, P = .03) d. Change in cognitive abilities from rehab admission to 4-week follow-up did not significantly affect the number of days to decannulation (P = .66). Secondary analysis showed pneumonia was associated with the largest estimated increase of 24.4 (95% CI 15.9-32.9, P < .001) d and that increased cognitive functioning at rehabilitation admission was associated with a significant reduction in time to decannulation.
CONCLUSIONS: This study found that a change in swallowing ability is a potentially significant factor for reducing time to decannulation. Identifying factors that could explain differences in time to decannulation is essential for patient outcomes, especially if these factors are modifiable and could be targeted in rehabilitation and treatment.
METHODS: This was a retrospective register-based cohort study. Subjects with moderate and severe TBI and a tracheal tube were selected from the Danish Head Trauma Database between 2011-2021. Time to decannulation was calculated as time from injury to decannulation. Associations between selected explanatory variables representing demographic and clinical characteristics and time to decannulation were analyzed using linear regression models.
RESULTS: A total 324 subjects were included with a median of 44 d to decannulation. Primary analysis found that an improvement in swallowing ability during the initial 4 weeks of rehabilitation was associated with an 8.2 d reduction in time to decannulation (95% CI -12.3 to -4.2, P < .001). Change in overall sensorimotor ability reduced time to decannulation by 0.94 (95% CI -0.78 to -0.10, P = .03) d. Change in cognitive abilities from rehab admission to 4-week follow-up did not significantly affect the number of days to decannulation (P = .66). Secondary analysis showed pneumonia was associated with the largest estimated increase of 24.4 (95% CI 15.9-32.9, P < .001) d and that increased cognitive functioning at rehabilitation admission was associated with a significant reduction in time to decannulation.
CONCLUSIONS: This study found that a change in swallowing ability is a potentially significant factor for reducing time to decannulation. Identifying factors that could explain differences in time to decannulation is essential for patient outcomes, especially if these factors are modifiable and could be targeted in rehabilitation and treatment.
摘要：
背景：严重创伤性脑损伤（TBI）后长时间放置气管导管可导致严重的并发症。安全移除需要足够的独立呼吸和气道保护能力。因此，确定拔除气管导管（拔管）时间的重要因素对于安全有效的断奶至关重要。这项研究旨在确定TBI后进行气管造口术的丹麦人群中拔管时间的重要因素。
方法：这是一项基于注册的回顾性队列研究。从2011-2021年的丹麦头部创伤数据库中选择患有中度和重度TBI和气管导管的受试者。将拔管时间计算为从损伤到拔管的时间。使用线性回归模型分析了代表人口统计学和临床特征的选定解释变量与拔管时间之间的关联。
结果：共纳入324名受试者，中位拔管时间为44d。初步分析发现，在康复的最初4周内，吞咽能力的改善与拔管时间减少8.2d相关（95％CI-12.3至-4.2，P<.001）。整体感觉运动能力的变化使拔管时间减少了0.94（95％CI-0.78至-0.10，P=.03）d。从康复入院到4周随访的认知能力的变化并没有显着影响拔管的天数（P=.66）。二次分析显示，肺炎与24.4d的最大估计增加相关（95％CI15.9-32.9，P<.001），并且康复入院时认知功能的增加与拔管时间的显着减少相关。
结论：这项研究发现，吞咽能力的变化是减少拔管时间的潜在重要因素。确定可以解释拔管时间差异的因素对患者预后至关重要，特别是如果这些因素是可以改变的，并且可以作为康复和治疗的目标。
方法：这是一项基于注册的回顾性队列研究。从2011-2021年的丹麦头部创伤数据库中选择患有中度和重度TBI和气管导管的受试者。将拔管时间计算为从损伤到拔管的时间。使用线性回归模型分析了代表人口统计学和临床特征的选定解释变量与拔管时间之间的关联。
结果：共纳入324名受试者，中位拔管时间为44d。初步分析发现，在康复的最初4周内，吞咽能力的改善与拔管时间减少8.2d相关（95％CI-12.3至-4.2，P<.001）。整体感觉运动能力的变化使拔管时间减少了0.94（95％CI-0.78至-0.10，P=.03）d。从康复入院到4周随访的认知能力的变化并没有显着影响拔管的天数（P=.66）。二次分析显示，肺炎与24.4d的最大估计增加相关（95％CI15.9-32.9，P<.001），并且康复入院时认知功能的增加与拔管时间的显着减少相关。
结论：这项研究发现，吞咽能力的变化是减少拔管时间的潜在重要因素。确定可以解释拔管时间差异的因素对患者预后至关重要，特别是如果这些因素是可以改变的，并且可以作为康复和治疗的目标。
