Management of tracheostomized patients after poor grade subarachnoid hemorrhage: Disease related and pulmonary risk factors for failed and delayed decannulation

Jan Küchler; Jann F Wojak; Emma Smith; Jan Brocke; Abdulkareem Abusamha; Volker M Tronnier; Claudia Ditz

doi:10.1016/j.clineuro.2019.105419

Management of tracheostomized patients after poor grade subarachnoid hemorrhage: Disease related and pulmonary risk factors for failed and delayed decannulation

Clin Neurol Neurosurg. 2019 Sep:184:105419. doi: 10.1016/j.clineuro.2019.105419. Epub 2019 Jul 8.

Authors

Jan Küchler¹, Jann F Wojak², Emma Smith², Jan Brocke³, Abdulkareem Abusamha², Volker M Tronnier², Claudia Ditz²

Affiliations

¹ Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. Electronic address: jan.kuechler@uksh.de.
² Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
³ Department of Neurorehabilitation, Segeberger Kliniken, Bad Segeberg, Germany.

PMID: 31306892
DOI: 10.1016/j.clineuro.2019.105419

Abstract

Objective: Tracheostomy is often indicated in patients with spontaneous subarachnoid hemorrhage (sSAH). Decannulation is a major goal of neurorehabilitation, but cannot be achieved in all patients. The aim of this study was to describe the course of decannulation and to identify associated risk factors in a single-center collective.

Patients and methods: We retrospectively reviewed 87 sSAH patients with WFNS (World Federation of Neurosurgical Societies) grade III-IV, who received tracheostomy. Decannulation events and the time from tracheostomy to decannulation were recorded in a 200-days follow-up. Variables analyzed were: age, sex, WFNS grade, Fisher grade, the presence of intracerebral or intraventricular hematoma, acute hydrocephalus, aneurysm location, aneurysm obliteration (surgical vs. endovascular), treatment related complications, decompressive craniectomy, symptomatic cerebral vasospasm, vasospasm-related infarction and timing of tracheostomy. Further risk factors analyzed were preexisting chronic lung disease and pneumonia. Functional outcome was assessed by the modified Rankin Scale (mRS).

Results: The rate of successful decannulation was 84% after a median of 47 days. A higher WFNS grade and pneumonia were associated with both a prolonged time to decannulation (TTD) and decannulation failure (DF). Older age (> 60 years) and necessity for decompressive craniectomy were only associated with prolonged TTD. Outcome analysis revealed that patients with DF show a significantly (p < 0.01) higher rate of unfavorable outcome (mRS 3-6).

Conclusion: Successful decannulation is possible in the majority of sSAH patients and particularly, in all patients with WFNS grade III. WFNS grading, age, the necessity for decompressive craniectomy and pneumonia are significantly associated with the TTD. WFNS grade and pneumonia are significantly associated with DF. The mean cannulation time of sSAH patients is shorter in relation to stroke patients.

Keywords: Decannulation; Decannulation failure; Neurorehabilitation; Spontaneous subarachnoid hemorrhage; Tracheostomy.

MeSH terms

Aged
Decompressive Craniectomy / methods*
Female
Humans
Male
Middle Aged
Risk Factors
Severity of Illness Index
Stroke / surgery*
Subarachnoid Hemorrhage / surgery*
Time Factors
Vasospasm, Intracranial / surgery*