Upper Airway Collapse in Patients With Severe Acquired Brain Injury Who Underwent Tracheostomy

Objective: To characterize upper airway collapse (UAC) in tracheostomized patients with severe acquired brain injury (sABI) and to explore its pathophysiology. Methods: This study involved adult patients with sABI who underwent tracheostomy and were consecutively admitted to the neurorehabilitation department of a tertiary teaching hospital from March 1, 2020, to March 1, 2023. Medical records and fiberoptic laryngobronchoscopy recordings of enrolled patients were reviewed retrospectively. The diagnosis of UAC was confirmed with the collapse of upper airway structures during inspiration when the tracheostomy was occluded. Baseline information of the enrolled patients and prognosis of the patients with UAC were collected. Logistic regression and bivariate comparisons were performed. Results: Of 180 patients identified, 38 (21.1%) had UAC: 30 experienced complete airway obstruction, whereas 8 had partial obstruction with a loss of airway patency exceeding 50%. Collapse sites included the velopharynx, oropharynx, epiglottis, and arytenoid area. Spontaneous resolution of UAC (n = 16) correlated with improved consciousness (p = 0.003), higher functional outcomes (p < 0.001), better oral intake ability (p = 0.004), and secretion management ability (p = 0.001). Fourteen patients were successfully decannulated after spontaneous resolution. Associated factors with UAC were minimally conscious state (OR: 13.80; p < 0.001), unresponsive wakefulness syndrome (OR: 28.43; p < 0.001), brainstem involvement (OR: 7.54; p < 0.001), and diabetes history (OR: 4.53; p = 0.002). Conclusions: UAC following severe brain injury presents a significant barrier to decannulation, particularly among those with decreased consciousness, brainstem involvement, and a history of diabetes. The resolution of UAC correlates with a favorable prognosis. These findings enhance our understanding of this condition and will aid in patient management.