Outcomes and complications following tracheostomy in neurocritical care unit: a prospective longitudinal study

Background:

Patients admitted to neurological critical care unit (NCCU) frequently require ventilator support and tracheostomy. This prospective longitudinal observational study collated outcomes following tracheostomy amongst patients admitted to NCCU.

Methods:

In this prospective longitudinal observational study, we collected a predetermined set of clinical data for all patients admitted to the NCCU who underwent tracheostomy, until they were discharged from the unit. Exploratory data analysis of the tracheostomy outcomes was performed to identify the clinical parameters influencing decannulation.

Results:

Fifty four (5.4%) of 999 consecutive patients admitted to NCCU required tracheostomy. The mortality among people who had tracheostomy was 11.1% (n = 6) and decannulation rate was 59.3% (n = 32). Tracheostomies were more commonly done in men, those admitted with GCS of 3.0 and had cerebrovascular accidents. Thirty (55.6%) patients had sialorrhea during their NCCU admission which demonstrated significant associations with the total length of NCCU admission, time taken for decannulation, admission GCS, Fiberoptic Endoscopic Evaluation of Swallowing (FEES) referrals, need to recannulate following decannulation, pulmonary infections, and oral candidiasis. Incidence of chest infections was higher prior to the institution of pharmacological management of oral secretions. Prevalence of oral candidiasis was higher among patients who received pharmacotherapies for oral secretion.

Conclusion:

Oral secretion issues increase incidences of pulmonary infections, delay decannulation, increase the need for recannulation, and prolong the stay of patients in NCCU. Pharmacological management of oral secretions was associated with a reduced incidence of chest infections and a shorter duration to achieve decannulation.