Resolution of Tracheostomy Complications by Decanulation and Conversion to Noninvasive Management for a Patient With High-Level Tetraplegia

Top Spinal Cord Inj Rehabil, 2012 · DOI: 10.1310/sci1802-193 · Published: January 1, 2012

Spinal Cord Injury Pulmonology Rehabilitation

Simple Explanation

This case report discusses switching a patient with a high spinal cord injury from a tracheostomy to noninvasive ventilation to resolve complications. The patient, who had no measurable vital capacity, was successfully transitioned to noninvasive intermittent positive pressure ventilation (NIV). The conversion allowed for the resolution of tracheostomy-associated complications and improved vocalization.

Study Duration

Not specified

Participants

A 38-year-old female with C1 ASIA-A tetraplegia

Evidence Level

Level IV; Case Report

Key Findings

1
Conversion to NIV resolved tracheostomy-associated complications like stomal enlargement and tracheal granulation.
2
The patient regained effective vocalization after the tracheostoma was surgically closed.
3
The patient was able to return to the community using NIV continuously without complications for 10 months.

Research Summary

The case report details the successful transition of a ventilator-dependent patient with high-level tetraplegia from tracheostomy to noninvasive ventilation (NIV). This transition was performed to address complications related to the tracheostomy, such as difficulty vocalizing due to stomal enlargement and tracheal granulation. The patient's management included nasal and oral interfaces for NIV, surgical closure of the ostomy, and training in assisted coughing techniques.

Practical Implications

Improved Quality of Life

Conversion to NIV can improve the quality of life for ventilator-dependent SCI patients by resolving tracheostomy complications and restoring vocalization.

Consideration of NIV

NIV should be considered for ventilator-dependent patients with adequate bulbar-innervated muscle function to permit effective speech and assisted coughing.

Wider Application

Increased expertise and availability of noninvasive management techniques can facilitate easier reintegration of severely disabled individuals into their communities.

Study Limitations

1
Single case report limits generalizability.
2
Difficulty finding local care providers experienced in noninvasive management.
3
Patient required several months to identify other local care providers.

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