Rehabilitative intervention for successful decannulation in adult patients with acquired brain injury and tracheostomy: a systematic review

Signe Janum Eskildsen; Irene Wessel; Ingrid Poulsen; Carrinna Aviaja Hansen; Derek John Curtis

doi:10.1080/09638288.2023.2233437

Rehabilitative intervention for successful decannulation in adult patients with acquired brain injury and tracheostomy: a systematic review

Disabil Rehabil. 2023 Jul 14:1-13. doi: 10.1080/09638288.2023.2233437. Online ahead of print.

Authors

Signe Janum Eskildsen^{1

2}, Irene Wessel³, Ingrid Poulsen^{2

4}, Carrinna Aviaja Hansen^{5

6}, Derek John Curtis⁷

Affiliations

¹ Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
² Department of Public Health, Aarhus University, Health, Aarhus, Denmark.
³ Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.
⁴ Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark.
⁵ Department of Orthopaedic Surgery, Zealand University Hospital, University of Copenhagen, Koege, Denmark.
⁶ Faculty of Health Sciences, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
⁷ Department of Pediatric Rehabilitation, Children's Therapy Center, The Child and Youth Administration, Copenhagen, Denmark.

PMID: 37449332
DOI: 10.1080/09638288.2023.2233437

Abstract

Purpose: Tracheostomy and dysphagia are independently associated with increased complications and poorer functional outcome after acquired brain injury (ABI). The aim of this study was to identify and evaluate rehabilitation to restore functional swallowing ability and respiratory capacity during tracheal tube weaning.

Materials and methods: The review was conducted according to PRISMA guidelines. Any study design with adult patients with ABI and tracheostomy was eligible. The primary outcome was decannulation.

Results: A total of 2647 records were identified and eight papers included. Four studies investigated pharyngeal electrical stimulation (PES), two explored Facial Oral Tract Therapy (F.O.T.T.), one respiratory physiotherapy (RPT), and one study investigated external subglottic air flow (ESAF). Two RCTs found a significant difference between intervention and control on successful decannulation and readiness for decannulation in favour of PES. Time from rehabilitation admission and tracheostomy to decannulation was significantly reduced after implementing an F.O.T.T.-based protocol.

Conclusion: Four interventions were identified, PES, F.O.T.T., RPT, and ESAF, all aimed at increasing oropharyngeal sensory input through stimulation. Due to heterogeneity of interventions, designs and outcome measures, effect could not be estimated. This review highlights the limited research on rehabilitative interventions and thus the limited evidence to guide clinical rehabilitation.

Keywords: Rehabilitation; brain injury; decannulation; systematic review; tracheostomy; weaning.

Plain language summary

Rehabilitation for early decannulation after brain injuryDysphagia and tracheostomy often coexist in neurocritical care and early rehabilitation.Four rehabilitative interventions were identified—pharyngeal electrical stimulation, external subglottic airflow, respiratory physiotherapy and facial-oral tract therapy.Interventions points to a consensus that sensory stimulation of the oropharynx can increase excitability of the swallowing network and support pharyngeal sensorimotor cortex reorganisation.This review highlights the limited research on therapeutic rehabilitative interventions and thus the limited evidence to guide clinical rehabilitation.

Publication types

Review