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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Anesthesiology 1/2018

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

Zeitschrift:
BMC Anesthesiology > Ausgabe 1/2018
Autoren:
Maria-Dorothea Heidler, Annett Salzwedel, Michael Jöbges, Olaf Lück, Christian Dohle, Michael Seifert, Andrea von Helden, Wibke Hollweg, Heinz Völler

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.
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