Int Arch Otorhinolaryngol 2014; 18(02): 108-114
DOI: 10.1055/s-0033-1363467
Original Research
Thieme Publicações Ltda Rio de Janeiro, Brazil

Tracheal Decannulation Protocol in Patients Affected by Traumatic Brain Injury

Isabel de Lima Zanata
1  Departamento de Fonoaudiologia, Hospital do Idoso Zilda Arns, Curitiba, PR, Brazil
,
Rosane Sampaio Santos
2  Departamento do Programa de Mestrado e Doutorado em Distúrbios da Comunicação, Universidade Tuiuti do Paraná, Curitiba, PR, Brazil
,
Gisela Carmona Hirata
3  Departamento de Disfagia, Universidade Tuiuti do Paraná, Curitiba, PR, Brazil
› Author Affiliations
Further Information

Publication History

17 March 2013

23 August 2013

Publication Date:
06 January 2014 (online)

  

Abstract

Introduction The frequency of tracheostomy in patients with traumatic brain injury (TBI) contrasts with the lack of objective criteria for its management. The study arose from the need for a protocol in the decision to remove the tracheal tube.

Objective To evaluate the applicability of a protocol for tracheal decannulation.

Methods A prospective study with 20 patients, ranging between 21 and 85 years of age (average 33.55), 4 of whom were women (20%) and 16 were men (80%). All patients had been diagnosed by a neurologist as having TBI, and the anatomical region of the lesion was known. Patients were evaluated following criteria for tracheal decannulation through a clinical evaluation protocol developed by the authors.

Results Decannulation was performed in 12 (60%) patients. Fourteen (70%) had a score greater than 8 on the Glasgow Coma Scale and only 2 (14%) of these were not able to undergo decannulation. Twelve (60%) patients maintained the breathing pattern with occlusion of the tube and were successfully decannulated. Of the 20 patients evaluated, 11 (55%) showed no signs suggestive of tracheal aspiration, and of these, 9 (82%) began training on occlusion of the cannula. The protocol was relevant to establish the beginning of the decannulation process. The clinical assessment should focus on the patient's condition to achieve early tracheal decannulation.

Conclusion This study allowed, with the protocol, to establish six criteria for tracheal decannulation: level of consciousness, respiration, tracheal secretion, phonation, swallowing, and coughing.