Rehabilitative Intervention for Successful Decannulation in Adult Patients With Acquired Brain Injury and Tracheostomy: A Systematic Review
Disability and Rehabilitation
Eskildsen, S. J., Wessel, I., et al. (2023).
Disability and Rehabilitation, 46(12), 2464-2476.
<div>This systematic review explores the impact of therapeutic interventions on tracheostomy tube weaning and decannulation in adults with severe acquired brain injury (ABI). This article summary includes findings relevant to speech-language pathology scope of practice.</div>
Danish Victim Fund; Occupational Therapy Foundation
From database inception to June 14, 2023
<div>Randomized and non-randomized controlled trials</div>
8 (6 within scope)
<div>Limited research yielded the following findings regarding the impact of therapeutic interventions in tracheotomized adults with ABI:</div>
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<ul>
<li><strong>Pharyngeal electrical stimulation (PES):</strong> PES generally resulted in improved decannulation (4 studies) and swallowing (2 studies) outcomes. While some serious adverse events (e.g., death, self-decannulation) occurred during the PES treatment period, it was difficult to determine if these events were related to the treatment.</li>
<li><strong>Facial-Oral Tract Therapy (FOTT):</strong> In one study, FOTT resulted in improved rates of decannulation (94% [33/35] versus 83% [10/12]), reduced time from admission to decannulation (28 versus 74 days), and reduced time from tracheostomy to decannulation (48 versus 95 days) when compared to historical controls. However, there was a higher rate of re-cannulation in those who received FOTT (6% versus 0%). FOTT had no treatment effect on swallowing (1 study).</li>
</ul>
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<div>These findings should be interpreted with caution due to limited available research, high risk of bias, heterogeneity between studies, and generally small sample sizes. Additional research is indicated to make any firm statements of treatment effectiveness in this population. </div>
