Successful decannulation of patients with traumatic spinal cord injury: A scoping review

The Journal of Spinal Cord Medicine, 2022 · DOI: 10.1080/10790268.2020.1832397 · Published: July 1, 2022

Spinal Cord Injury Critical Care Surgery

Simple Explanation

Patients with spinal cord injuries (SCI) often need a tracheostomy to help them breathe. Removing the tracheostomy, called decannulation, can improve their life quality and appearance. This study reviewed existing research on SCI patients who have undergone decannulation to understand the process and outcomes. The review found that managing decannulation with a specialized team and using non-invasive ventilation techniques can help patients. However, there's a lack of consistent reporting on outcomes after decannulation.

Study Duration

Not specified

Participants

26 publications (scoping review)

Evidence Level

Level 4: Scoping Review (primarily retrospective case series and reports)

Key Findings

1
Interdisciplinary tracheostomy teams (ITT) improve communication and operational processes, enhancing decannulation outcomes.
2
Non-invasive intermittent positive-pressure ventilatory support (NIVS) can facilitate decannulation, but its adoption is limited despite its benefits.
3
There is a lack of consistent taxonomy for reporting post-decannulation outcomes in SCI patients, hindering comparisons across studies.

Research Summary

This scoping review synthesized existing literature on decannulation in SCI patients, identifying 26 eligible publications primarily from physical medicine, neurology, and pulmonary/critical care fields. Key themes include the importance of interdisciplinary tracheostomy teams, the use of non-invasive ventilatory support, and the wide variation in reporting post-decannulation outcomes. The review highlights the need for a consistent taxonomy for reporting outcomes and further investigation into the socioeconomic impact of tracheostomies on SCI patients.

Practical Implications

Team-Based Care

Implementing interdisciplinary tracheostomy teams can improve communication and streamline the decannulation process for SCI patients.

Non-Invasive Ventilation

Promoting the use of non-invasive ventilation techniques can help patients avoid or remove tracheostomies, improving their quality of life.

Standardized Reporting

Developing a standardized taxonomy for reporting post-decannulation outcomes is crucial for comparing studies and improving patient care.

Study Limitations

1
The wide range of study designs and reported outcomes restricted quantitative analysis.
2
The review did not search the grey literature, potentially missing relevant information.
3
The NIVS literature was dominated by a single authorship group, with risks of publication bias.

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