Development and Effect Evaluation of an Action-Oriented Interdisciplinary Weaning Protocol for Cuffed Tracheostomy Tubes in Patients with Acquired Brain Injury
Abstract
1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Development of the Action Oriented IWP
2.3. Search Strategy
2.4. Patient Population for Effect Evaluation of the IWP
3. Results
3.1. Action-Oriented IWP
- Each of the three protocols provide the interdisciplinary team with guidance on the weaning process, which must be adapted to the individual patient [8,12]. The IWP present both suggestions for cuff-deflation intervals and for treatment and therapy [10,27]. Treatment and therapy [5,28] encompass, e.g., interventions related to meal situations and oral hygiene [29,30,31], tactile stimulation [15,30,31,32], mobilization of the tongue [30,32], facilitation of swallowing [30,31], ACV [7,27], neuromuscular electrical stimulation, chin-tuck, effortful swallow, supraglottic swallow, the Mendelsohn maneuver [33], and pharmacological agents to reduce the production of saliva [5].
Protocol Criteria | Description | Comment | References |
---|---|---|---|
Conscious/verbal address | Some consciousness and/or response to verbal address. | There is no consensus on whether consciousness has an impact in relation to a successful weaning from the tracheostomy tube. | [5,10,14,15] |
Postural control | Able to sit upright with some degree of head control. | This is also a prerequisite for oral intake of food and liquids. | [10,15] |
Saliva management | Some oral transport of saliva. | The literature indicates that some oral transport of saliva increases the chance of a successful decannulation. | [5,10,15] |
Swallowing of saliva | Spontaneous or facilitated swallowing of saliva. | It has been suggested that spontaneous or facilitated swallowing of saliva has an impact on weaning from tracheostomy tubes. | [5,10,14,15] |
Cough reflex and strength | Spontaneous and effective cough reflex and strength. | It is suggested that cough reflex and strength are important criteria to assess, but without having consensus on how to measure it. | [5,10,14,25,34] |
Reflux/vomiting | No or little problems with reflux and vomiting. | Patients that cannot protect their lower airways are at higher risk of pneumonia if they have issues with reflux and vomiting. | [5,34] |
Saliva above the cuff | Saliva above the cuff measured several times a day. | Cuffed tracheostomy tubes with a suction aid is preferred. However, there is no consensus on cutoff value on the amount of saliva above the cuff. | [35] |
Respiratory frequency | <25 | No obstruction of the upper respiratory tract. | [5,14,34] |
Heart rate | <100 | A normal resting heart rate for adults ranges 60–100 beats per minute. | [36] |
Saturation | >92% | Breathing room air or with supplemented oxygen. | [5,10,34] |
Infections | No active infection. | Recommended before proceeding with weaning and decannulation. | [5,37,38,39] |
CO2 Measurement | PaCO2 < 60 mmHg | If deemed necessary. | [14] |
3.2. Effect Evaluation of the IWP
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Before IWP, n = 161 | After IWP, n = 176 | p-Value | |
---|---|---|---|
Age | 56 (45–66) | 55 (44–64) | 0.338 |
Sex | 0.133 | ||
• Women | 29% | 36% | |
• Men | 71% | 64% | |
Diagnosis | 0.389 | ||
• Ischemic stroke | 15% | 11% | |
• Hemorrhagic stroke | 22% | 18% | |
• SAH | 15% | 17% | |
• Stroke NOS # | 4% | 12% | |
• TBI | 27% | 28% | |
• Anoxic brain injury | 10% | 4% | |
• Brain tumor | 1% | 3% | |
• Encephalopathy NOS | 7% | 7% | |
Day from injury until admission | 31 (22–40) | 31 (21–41) | 0.868 |
FIM at admission | 18 (18–21) | 18 (18–20) | 0.581 |
EFA at admission | 42 (34–50) | 40 (32–50) | 0.324 |
• No aspiration risk | 1% | 1% | 1.000 |
• Stable yes/no communication | 20% | 17% | 0.571 |
• Head control ¤ | 28% | 21% | 0.158 |
• Postural control § | 10% | 9% | 0.851 |
Variable | Cases/Subjects | Unadjusted HR (95%CI) | Adjusted HR (95%CI) |
---|---|---|---|
Weaning protocol | |||
• Following IWP | 131/176 | 1.341 (1.038; 1.731) | 1.309 (1.013; 1.693) |
• Before IWP | 111/161 | Ref. | Ref. |
Sex | |||
• Men | 158/227 | 0.733 (0.562; 0.957) | 0.753 (0.576; 0.983) |
• Women | 84/110 | Ref. | Ref. |
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Bjerrum, K.; Grove, L.-M.D.; Mortensen, S.S.; Fabricius, J. Development and Effect Evaluation of an Action-Oriented Interdisciplinary Weaning Protocol for Cuffed Tracheostomy Tubes in Patients with Acquired Brain Injury. Healthcare 2024, 12, 480. https://doi.org/10.3390/healthcare12040480
Bjerrum K, Grove L-MD, Mortensen SS, Fabricius J. Development and Effect Evaluation of an Action-Oriented Interdisciplinary Weaning Protocol for Cuffed Tracheostomy Tubes in Patients with Acquired Brain Injury. Healthcare. 2024; 12(4):480. https://doi.org/10.3390/healthcare12040480
Chicago/Turabian StyleBjerrum, Katje, Linda-Maria Delgado Grove, Sine Secher Mortensen, and Jesper Fabricius. 2024. "Development and Effect Evaluation of an Action-Oriented Interdisciplinary Weaning Protocol for Cuffed Tracheostomy Tubes in Patients with Acquired Brain Injury" Healthcare 12, no. 4: 480. https://doi.org/10.3390/healthcare12040480
APA StyleBjerrum, K., Grove, L.-M. D., Mortensen, S. S., & Fabricius, J. (2024). Development and Effect Evaluation of an Action-Oriented Interdisciplinary Weaning Protocol for Cuffed Tracheostomy Tubes in Patients with Acquired Brain Injury. Healthcare, 12(4), 480. https://doi.org/10.3390/healthcare12040480