200 Section - Looking Beyond FIM Gains: A Case Series of Successful Decannulation of Tracheostomized Patients In a Neurorehabilitation Unit Following Acquired Brain Injury

Case Diagnosis: Successful early decannulation of 3 tracheostomized patients in a neurorehabilitation unit following acquired brain injury. We established a rehabilitation unit within a neuroscience ward in an acute hospital, admitting 70 suitable patient for tertiary rehabilitation from January to September 2025. Of these, 55 were stroke and traumatic brain injury cases, and 3 were tracheostomized. This retrospective case series investigates these 3 patients and their primary outcome – time to decannulation.

Case Description: Patients are made known to a multidisciplinary workgroup tracheostomy weaning workgroup and trial of spigotting initiated once criteria is met upon admission to the unit. The team followed a Tracheostomy Weaning Workflow with an “fast-track” spigotting and decannulation protocol over a 2 day duration, and the decannulation being performed in the morning on Day 3.

Discussions: They were successfully decannulated at an average of 52 days post-tracheostomy, while traditionally they would have been decannulated at 90 days post-tracheostomy. This is at least 4 weeks prior to their scheduled ENT appointment for trial of decannulation. We also documented secondary outcomes like safety events. There was no need for recannulation within 72 hours, 7 days, and 30 days, no incidences of aspiration pneumonia and no mortality. Average length of stay in the unit was 46 days. Importantly, discharge destination was to their own homes for 2 of the patients, and 1 went to a transitional care facility.

Conclusions: The earlier decannulation and avoidance of nursing home and chronic sick unit admission have greatly impacted and reduced the cost of care for these patients and caregivers. With a proactive multi-disciplinary approach, we feel this is likely to be a sustainable effort to reduce length of hospital stay, avoid high cost care needs of a prolonged tracheostomized patient both in an in- and outpatient setting, and ultimately improve care efficiency.