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Original report

Retrospective analysis of functional and tracheostomy (decannulation) outcomes in patients with brain injury in a hyper-acute rehabilitation unit

Lin Cheng, Kay Mitton, Krystyna Walton, Manoj Sivan
Rehabilitation Medicine, Salford Royal Hospital, United Kingdom
DOI: 10.2340/20030711-1000024

Abstract

Objectives: Hyper-Acute Rehabilitation Units (HARUs) provide multidisciplinary rehabilitation to patients with acute neurological injuries. This includes managing patients with tracheostomies. This is the first study of its kind to examine clinical outcomes in patients with brain injury and tracheostomy managed in a HARU.
Methods: Retrospective analysis of clinical outcomes in tracheostomy patients admitted to a HARU over a 2-year period.
Results: A total of 208 patients were admitted to the HARU, of whom 99 (60 males and 39 females) had a tracheostomy either at admission or during their stay in the HARU. Mean Glasgow Coma Scale
score at admission was 11 (range 5–15) and at discharge was 13 (range 8–15). Mean Functional Independence Measure and Functional Assessment Measure (FIM+FAM) score improved from 52 at admission to 95 at discharge. Mean FIM+FAM cognitive admission cognitive sub-score improved from 23 to 42, and mean motor sub-score from 29 to 42. Changes in scores were deemed to be clinically significant as per thresholds reported in the literature. Of the total patients in this study, 79% were successfully decannulated and 21% needed long-term tracheostomy.
Conclusion: Patients with tracheostomy following brain injury can be appropriately managed in a HARU and show clinically significant improvement in functional outcomes.

Lay Abstract

A Hyper-Acute Rehabilitation Unit (HARU) provides rehabilitation to patients with sudden neurological injury, such as traumatic brain injury or stroke. In order to maintain a safe airway some of these patients have an artificial tube inserted into the trachea through an
opening in the neck. This procedure is called a tracheostomy.
This study analysed outcomes in tracheostomy patients admitted to a HARU over a 2-year period. A total of 208 patients were admitted to the unit, of whom 99 had a brain injury and had had a tracheostomy, either at admission or during their stay in the HARU. Functional activity, measured using Functional Independence Measure and Functional Assessment Measure (FIM+FAM) scales, showed significant improvement in both physical and mental ability in these patients. The tracheostomy tubes were removed successfully in 79% of patients as they became more independent and able to maintain their airway. However, long-term tracheostomy was needed in 21% of patients. This study shows that patients who have a tracheostomy following an acute neurological injury can be managed appropriately in a HARU and improve in functional ability.

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