Tracheal lesions after tracheotomy in patients with acquired brain injury: Incidence, associated factors and impact on rehabilitation.

Objective Management of tracheotomy is a key point of the coma arousal phase. Tracheal lesions can interfere with the decannulation of the patient. The objectives of our study were to determine the incidence of post-tracheotomy tracheal lesions in patients with brain injury, identify their associated factors and to specify their impact on rehabilitation. Material/patients and methods We retrospectively included brain-injured patients hospitalized in the neurosurgical intensive care unit then in the coma arousal unit of the Lille university hospital between January 2012 and December 2014. All patients had a tracheotomy and benefited from an endoscopy prior and/or after decannulation. Data from intensive care unit and rehabilitation hospitalizations were collected to analyze factors associated with tracheal lesions and the impact on rehabilitation. Results Fifty-six patients were included. Thirty (53.6%) had a tracheal lesion, which was most of the time asymptomatic. The duration of stay in intensive care unit was significantly longer in the group with tracheal lesion (medians and interquartile ranges respectively: 54 [29] vs 42 [16] days, P  = 0.012). Decannulation tended to take place later for patients presenting with a tracheal lesion (74 [60] vs 40 [69] days after the tracheotomy). The hospitalization in neurorehabilitation unit was also significantly longer for patients with tracheal lesion (181 [182] vs 149 [248] days). The refeeding process tended to start later in patients presenting with a tracheal lesion (71 [78.5] days) than in the group without tracheal lesion (61.5 [68]), but the return to a normal texture occurred at the same time. Discussion - conclusion Tracheal lesions after tracheotomy are common in patients at the coma arousal phase after an acquired brain lesion. They are often asymptomatic at this stage, and seem to delay decannulation and refeeding processes.