Tracheostomy Decannulation; A Catch-22 for Patients with Spinal Cord Injuries

Abstract

Challenges of TT decannulation in patients with spinal cord injuries (SCI) are of particular importance. Respiratory complications are common in acute SCI patients and tracheostomy is regularly required, particularly in patients with tetraplegia [4]. The frequencies of tracheostomy in patients with tetraplegia are reportedly ranging from 16% to 30% with a median of 31 days from the time of tracheostomy to decannulation [5]. In comparison to this, forty years ago, Bellamy reported that 77% of SCI patients with complete and 33% with incomplete tetraplegia underwent tracheostomy, out of which, 40% of the complete and 21 % of incomplete died in the first year [6]. SCI patients are a unique group of population that may not satisfy the routine criteria for decannulation. One of the major reasons is that they may be aspirating their secretions. Aspiration is defined as “passage of material below the vocal folds into the trachea” [7]. This reflects the inability to protect the airway and is usually considered