A formalised process for decannulation reduced number of days with tracheostomy for people with an acquired brain injury: a systematic review and meta-analysis

Background There is a high incidence of tracheostomy tube placement in patients with acquired brain injury. Due to complex sensory, motor and cognitive presentations, these patients often require long-term tracheostomy tubes, which can result in secondary complications. There is broad variability in tracheostomy management and decannulation decision-making in the literature, with an absence of evidence-based guidelines. The aim of this study was to identify if using a formalised process for decannulation reduced the number of days with tracheostomy for people with an acquired brain injury.Methods A systematic review of the literature available through MEDLINE, Embase and CINAHL was conducted on 8 August 2022. Studies were eligible if they compared a formalised process for decannulation to usual care reporting outcome measures for total number of days with a tracheostomy. Eligible studies were assessed using the Cochrane risk-of-bias tool (RoB 2). Meta-analysis for primary outcome was completed using a random-effects model.Results Five studies met the inclusion criteria, with a total number of 375 participants. Meta-analysis showed that the total number of days with tracheostomy decreased when a formalised process for decannulation was introduced (mean difference -10.66 days, 95% confidence interval [-20.52, -0.81], P = 0.03). All articles were rated high risk of bias as per the RoB 2.Conclusion There is evidence that using a formalised process for decannulation reduced the number of days with tracheostomy for people with an acquired brain injury. More rigorous research is required.Clinical Trial Registration PROSPERO, registration number CRD42021252053 People with acquired brain injuries often require long-term tracheostomy tubes, yet there is a lack of standardised guidelines for decannulation that consider the complex motor, sensory, and cognitive presentations. This systematic review found evidence that a formalised process for decannulation reduced the duration of tracheostomy for individuals with acquired brain injuries. This finding holds significance for clinical practice and underscores the need for further, more rigorous research.