Hauke Schneider1, Franziska Hertel2, Matthias Kuhn3, Maximilian Ragaller4, Birgit Gottschlich4, Anne Trabitzsch5, Markus Dengl6, Marcus Neudert7, Heinz Reichmann2, Sigrid Wöpking2. 1. Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. hauke.schneider@uniklinikum-dresden.de. 2. Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. 3. Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany. 4. Department of Anesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany. 5. Surgery Center, University Hospital, Technische Universität Dresden, Dresden, Germany. 6. Department of Neurosurgery, University Hospital, Technische Universität Dresden, Dresden, Germany. 7. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Technische Universität Dresden, Dresden, Germany.
Abstract
BACKGROUND: Tracheostomy is performed in ventilated stroke patients affected by persisting severe dysphagia, reduced level of consciousness, or prolonged mechanical ventilation. The study aim was to determine the frequency and predictors of successful decannulation and long-term functional outcome in tracheotomized stroke patients. METHODS: A prospective single-center observational study recruited ventilated patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Follow-up visits were performed at hospital discharge, 3, and 12 months. Competing risk analyses were performed to identify predictors of decannulation. RESULTS: We included 53 ventilated stroke patients who had tracheostomy. One year after tracheostomy, 19 patients were decannulated (median [IQR] time to decannulation 74 [58-117] days), 13 patients were permanently cannulated, and 21 patients died without prior removal of the cannula. Independent predictors for decannulation in our cohort were patient age (HR 0.95 [95% CI: 0.92-0.99] per one year increase, p = 0.003) and absence of sepsis (HR 4.44 [95% CI: 1.33-14.80], p = 0.008). Compared to surviving patients without cannula removal, decannulated patients had an improved functional outcome after one year (median modified Rankin Scale score 4 vs. 5 [p < 0.001]; median Barthel index 35 vs. 5 [p < 0.001]). CONCLUSIONS: Decannulation was achieved in 59.4% of stroke patients surviving the first 12 months after tracheostomy and was associated with better functional outcome compared to patients without decannulation. Further prospective studies with larger sample sizes are needed to confirm our results.
BACKGROUND: Tracheostomy is performed in ventilated strokepatients affected by persisting severe dysphagia, reduced level of consciousness, or prolonged mechanical ventilation. The study aim was to determine the frequency and predictors of successful decannulation and long-term functional outcome in tracheotomized strokepatients. METHODS: A prospective single-center observational study recruited ventilated patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Follow-up visits were performed at hospital discharge, 3, and 12 months. Competing risk analyses were performed to identify predictors of decannulation. RESULTS: We included 53 ventilated strokepatients who had tracheostomy. One year after tracheostomy, 19 patients were decannulated (median [IQR] time to decannulation 74 [58-117] days), 13 patients were permanently cannulated, and 21 patients died without prior removal of the cannula. Independent predictors for decannulation in our cohort were patient age (HR 0.95 [95% CI: 0.92-0.99] per one year increase, p = 0.003) and absence of sepsis (HR 4.44 [95% CI: 1.33-14.80], p = 0.008). Compared to surviving patients without cannula removal, decannulated patients had an improved functional outcome after one year (median modified Rankin Scale score 4 vs. 5 [p < 0.001]; median Barthel index 35 vs. 5 [p < 0.001]). CONCLUSIONS: Decannulation was achieved in 59.4% of strokepatients surviving the first 12 months after tracheostomy and was associated with better functional outcome compared to patients without decannulation. Further prospective studies with larger sample sizes are needed to confirm our results.
Authors: Silvia Schönenberger; Wolf-Dirk Niesen; Hannah Fuhrer; Colleen Bauza; Christina Klose; Meinhard Kieser; José I Suarez; David B Seder; Julian Bösel Journal: Int J Stroke Date: 2016-01-05 Impact factor: 5.266
Authors: Julian Bösel; Wolf-Dirk Niesen; Farid Salih; Nicholas A Morris; Jeremy T Ragland; Bryan Gough; Hauke Schneider; Jan-Oliver Neumann; David Y Hwang; Phani Kantamneni; Michael L James; William D Freeman; Venkatakrishna Rajajee; Chethan Venkatasubba Rao; Deepak Nair; Laura Benner; Jan Meis; Christina Klose; Meinhard Kieser; José I Suarez; Silvia Schönenberger; David B Seder Journal: JAMA Date: 2022-05-17 Impact factor: 157.335
Authors: Sarah Wahlster; Monisha Sharma; Frances Chu; Justin H Granstein; Nicholas J Johnson; W T Longstreth; Claire J Creutzfeldt Journal: Neurocrit Care Date: 2020-10-09 Impact factor: 3.210