A Study of Difficulty in Decannulation of Tracheostomized Head Injury Patients

A prospective observational study was done with the aim to analyze the difficulties during decannulation of tracheostomized head injury patients and to devise a sound protocol for decannulation. It was done over 2 years in a tertiary care Army Hospital with 40 tracheostomized head injury cases in the age group of 10-70 years. Once the indication of tracheostomy was over, their Glasgow Coma Scale score, airway adequacy, phonation, swallowing, cough reflex, and lung pathology were assessed. Fit patients were decannulated if they tolerated tube capping for 3 days. Data was statistically analyzed. Road traffic accident was the cause of head injury in 90% cases. 45% patients had traumatic brain injury. All the cases required ventilatory support. 80% patients required neurosurgery. Tracheostomy was done between 5th to 10th day. Decannulation could be achieved in 75% patients. Factors like neurological status, duration of ventilatory need, number of days on T piece, cough reflex, suction requirement, phonation, consistency of tracheal secretion, lung condition, and three days? capping of tracheostomy tube were significantly associated with outcome of decannulation trial (p <0.05). Factors like mode of injury, neurosurgical intervention, absence of phonation, and downsizing of tube did not affect the outcome significantly (p >0.05). The factors like strong cough reflex, thin minimal tracheal secretion, aspiration free swallowing, better GCS score, early weaning from ventilator and younger age favour early successful decannulation. Gradual downsizing of tube or presence of phonation are not essential prerequisites for decannulation.