Lu Song, Yong Wang, Hai Dong Li, Zheng Li, Su Juan Liu
{"title":"接受气管切开术的重症后发性脑损伤患者的上气道塌陷。","authors":"Lu Song, Yong Wang, Hai Dong Li, Zheng Li, Su Juan Liu","doi":"10.1002/lary.32138","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To characterize upper airway collapse (UAC) in tracheostomized patients with severe acquired brain injury (sABI) and to explore its pathophysiology.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Upper Airway Collapse in Patients With Severe Acquired Brain Injury Who Underwent Tracheostomy.\",\"authors\":\"Lu Song, Yong Wang, Hai Dong Li, Zheng Li, Su Juan Liu\",\"doi\":\"10.1002/lary.32138\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To characterize upper airway collapse (UAC) in tracheostomized patients with severe acquired brain injury (sABI) and to explore its pathophysiology.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: 3: </strong></p>\",\"PeriodicalId\":49921,\"journal\":{\"name\":\"Laryngoscope\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-03-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Laryngoscope\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/lary.32138\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laryngoscope","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/lary.32138","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
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.
期刊介绍：
The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope.
• Broncho-esophagology
• Communicative disorders
• Head and neck surgery
• Plastic and reconstructive facial surgery
• Oncology
• Speech and hearing defects
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