Affiliations: [a] Department of Rehabilitation Medicine (Neurology), Salford Royal Hospital, Salford, UK
| [b] Rakehead Rehabilitation Centre, Burnley General Hospital, Burnley, UK
| [c] Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| [d] Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
Correspondence:
[*]
Address for correspondence: Dr Hollie Ringrose, MRCP, Locum Consultant in Rehabilitation Medicine, Rakehead Rehabilitation Centre, Burnley General Teaching Hospital, Casterton Avenue, Burnley, BB10 2PQ, UK. Tel.: +44 01282 804822; E-mail: hollie.ringrose@nhs.net.
Abstract: BACKGROUND:Rehabilitation following severe Traumatic Brain Injury (TBI) often involves the use of temporary tracheostomies. Tracheostomy weaning is influenced by physiological parameters, which are abnormal in the concomitant complication of Paroxysmal Sympathetic Hyperactivity (PSH). OBJECTIVE:To investigate the association between PSH and tracheostomy weaning in severe TBI. METHODS:This was a retrospective cohort study of consecutive patients with TBI and tracheostomy admitted to a Hyper-Acute Neurorehabilitation Unit over a 34-month period. Duration of tracheostomy wean and influencing characteristics were statistically compared between those with and without PSH. RESULTS:Fifty-one patients admitted with TBI required a tracheostomy. Of these, 10 patients were also diagnosed with PSH. The mean tracheostomy wean in the PSH group was longer compared to the non-PSH group (72.3, SD 61.0 versus 30.0 days, SD 16.2). This difference was statistically significant (p = 0.007, using Mann Whitney U test). The PSH group had more respiratory and oral secretions, but this was not statistically significant (p = 0.16 and 0.29). CONCLUSIONS:This is the first study to demonstrate that PSH is associated with prolonged tracheostomy weaning in severe TBI. Awareness of this association should enable those planning rehabilitation to set realistic goals for a patient’s tracheostomy weaning programme.
Keywords: Paroxysmal autonomic instability, dystonia, intensive care, neurorehabilitation
