Acute neurorehabilitation: does a neurosensory and coordinated interdisciplinary programme reduce tracheostomy weaning time and weaning failure?
OBJECTIVE
A new coordinated interdisciplinary unit was created in the acute section of the department of clinical neurosciences, the Acute NeuroRehabilitation (NRA) unit. The objective was to evaluate the impact of the unit and its neurosensory programme on the management of tracheostomy patients in terms of reduction in the average time taken for weaning, weaning success rate and therapeutic efficiency.


METHODS
This 49-month retrospective study compares 2 groups of tracheostomy patients before (n = 34) and after (n = 46) NRA intervention. The outcome measures evaluate the benefits of the NRA unit intervention (time to decannulation, weaning and complication rates) and the benefits of the coordination (time to registration in a rehabilitation centre and rate of non-compliance with standards of care).


RESULTS
Weaning failure rate was reduced from 27.3% to 9.1%, no complications or recannulations were observed in the post-intervention group after weaning and time to decannulation following admission to our unit decreased from 19.13 to 12.75 days. The rate of non-compliance with patient standards of care was significantly reduced from 45% to 30% (Mann-Whitney p = 0.003).


CONCLUSIONS
This interdisciplinary weaning programme helped to reduce weaning time and weaning failure, without increased complications, in the sample studied. Coordination improved the efficiency of the interdisciplinary team in the multiplicity and complexity of the different treatments.
NeuroRehabilitation Unit, Department of Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Loric
L
Berney
NeuroRehabilitation Unit, Department of Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Jean-Blaise
JB
Wasserfallen
Department of Surgery and Anesthesiology, Department of Intensive Care and Emergency, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Kathleen
K
Grant
Neurosurgery, Department of Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Marc
M
Levivier
Department of Oto-Rhino-Laryngology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Christian
C
Simon
Institute of Social and Preventive Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Mohamed
M
Faouzi
Physiotherapy, University Hospital of Lausanne, Lausanne, Switzerland.
Roland
R
Paillex
Phoniatry Unit, Department of Oto-Rhino-Laryngology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Valérie
V
Schweizer
NeuroRehabilitation Unit, Department of Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Karin
K
Diserens
D002985:Clinical Protocols / Q000592:standards; D020878:Device Removal / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D056888:Patient Positioning; D015397:Program Evaluation; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects; D016896:Treatment Outcome
Neurorehabilitation; multidisciplinary approach; neurosensory; tracheostomy