RESUMO
BACKGROUND: Tracheostomy is a frequent surgical procedure in subjects with chronic disorders of consciousness (DOC). There is no consensus about safety of tracheostomy decannulation in this population.The aim of our study was to estimate if DOC improvement is a predictor for tracheostomy decannulation. Secondary outcomes include mortality rate and discharge destination. METHODS: We conducted an observational, retrospective, case-control study at a weaning and rehabilitation center (WRC). We included tracheostomized subjects with DOC admitted between August 2015 and December 2017. We matched groups based on the consciousness level at admission assessed withthe coma recovery scale revised (CRS-R). Subjects who were later decannulated formed the cases, while those that remained tracheostomized at the end of follow-up formed the controls. Improvement of DOC was defined as a progress in the categories of the CRS-R. RESULTS: 22 subjects were included in each group. No significant differences were found in clinical and demographic variables, except that controls had longer neurologic injury evolution (65.5 vs 51 days, P = .047), more tracheostomy days at admission to ourinstitution (53 vs 33.5, P = .02), and higher prevalence of neurological comorbidities (12 vs 4, P = .03). Subjects who improved their DOC had more chances of being decannulated (OR 11.28, 95% CI 1.96-123.08). Tracheostomy decannulation could not be achieved in most subjects who did not improve from vegetative state (VS) (OR 0.13, 95% CI 0.02-0.60). 8 subjects, however, could be decannulated in VS, with only one decannulation failure and no deaths. Mortality was higher in controls (0 vs 6, P = .02), especially among VS (0 vs 5, P = .049). No significant differences were found in discharge destination between groups. CONCLUSIONS: Subjects who improve their DOC are more likely to achieve tracheostomy decannulation. Some subjects in VS were decannulated, with lower mortality than those who remained tracheostomized.
Assuntos
Estado de Consciência , Traqueostomia , Estudos de Casos e Controles , Remoção de Dispositivo , Humanos , Estudos RetrospectivosRESUMO
Alrededor del mundo existe una gran cantidad de niños con dificultades cognitivas producto de daño cerebral o trastornos del neurodesarrollo. Estas dificultades traen consigo dificultades de tipo escolar, social, familiar y conductual, entre otras, disminuyendo así la calidad de vida del niño y su familia. Consecuentemente han aumentado en la literatura los artículos que evalúan la utilidad de diferentes programas de rehabilitación neuropsicológica.El objetivo de esta revisión fue (1) determinar cuáles son las modalidades teóricas de rehabilitación neuropsicológica más utilizadas, (2) establecer si se reportanganancias funcionales posteriores a cada intervención y, (3) establecer si durante la intervención se incluyó a los familiares. Los resultados mostraron que la principal modalidad de rehabilitación utilizada fue la restauración. Además, la mayoría de estudios no reportaban de manera clara ganancias funcionales ni incluían a la familia en el proceso terapéutico. Es necesario la realización de estudios que incluyan en su diseño diferentes modalidades de rehabilitación, apoyo familiar y evaluación de las ganancias funcionales...(AU)
Around the world, there are many children with cognitive difficulties as results of brain injury or neurodevelopmental disorders. These difficulties lead to school, social, family Archivos and behavioral disturbances, among others; and reduce the quality of life of the child and his family. Consequently, more papers are published in scientific literature that evaluate the usefulness of several neuropsychological rehabilitation programs. This review aimed (1) to determine which are the most frequently used theoretical models of neuropsychological rehabilitation, (2) to determine if functional gains were reported and, (3) whether during the intervention caregivers were included. The results showed that function restauration was the more frequently rehabilitation model used. Furthermore, most studies did not clearly report functional gains or caregivers' participation in the rehabilitation. Future studies should include in their design different rehabilitation models, family support and evaluation of functional gains...(AU)