ABSTRACT

Decannulation is a rehabilitation milestone in patients with Disorders of Consciousness (DoC). investigate the relationship between decannulation and improvement of responsiveness (IR) in DoC. 236 tracheostomized patients with severe Acquired Brain Injury and DoC admitted in the Intensive Rehabilitation Unit were retrospectively included. They received personalized interdisciplinary rehabilitation. At discharge, IR was evaluated. The association between IR and demographic/clinical data was investigated using a logistic regression analysis, both in the Unresponsive Wakefulness Syndrome (UWS) and Minimal Consciousness State (MCS) group, divided according to their Coma Recovery Scale-Revised score at admission. In the UWS group (N = 107), only decannulation was associated with IR at discharge (OR: 5.94, CI: 2.08–16.91, p = .001). In the MCS group (N = 129) time post-injury (OR: 0.983, CI: 0.97–0.99, p = .012) and decannulation were associated with IR at discharge (OR: 17.9, CI: 6.39–50.13, p < .001). Decannulation and IR were found to be strongly related, independently from the initial clinical state. While the retrospective nature of the study could not exclude that decannulation may be a consequence of a spontaneous recovery, the obtained results may disclose its potential influence on the clinical history of patients with DoC.

摘要

拔管是意识障碍 (DoC) 患者康复的里程碑。研究拔管与 DoC 中反应性 (IR) 改善之间的关系。回顾性纳入了重症康复科收治的 236 名患有严重获得性脑损伤和 DoC 的气管切开术患者。他们接受了个性化的跨学科康复。在出院时，评估IR。IR 与人口统计/临床数据之间的关联使用逻辑回归分析进行调查，在无反应觉醒综合征 (UWS) 和最小意识状态 (MCS) 组中，根据入院时的昏迷恢复量表修订评分进行划分。在UWS组（N = 107），只有拔管与出院时的 IR 相关（OR：5.94，CI：2.08–16.91，p  = .001）。在 MCS 组 ( N  = 129) 受伤后时间 (OR: 0.983, CI: 0.97–0.99, p  = .012) 和拔管与出院时的 IR 相关 (OR: 17.9, CI: 6.39–50.13, p  < .001)。发现拔管和 IR 密切相关，独立于初始临床状态。虽然该研究的回顾性不能排除拔管可能是自发恢复的结果，但获得的结果可能揭示其对 DoC 患者临床病史的潜在影响。