Predictors of successful decannulation in patients with chronic disorders of consciousness and tracheostomy.

OBJECTIVE: To investigate the independent predictive factors for successful decannulation in patients with chronic disorders of consciousness (pDoC), and to provide evidence for clinical decision-making regarding safe tracheostomy tube removal. METHODS: We conducted a single-center retrospective cohort study and consecutively enrolled 156 patients with tracheotomy and post-disorders of consciousness (pDoC) who were admitted from January 2022 to June 2025. Data on demographics, etiology, level of consciousness (assessed using the Coma Recovery Scale–Revised, CRS-R), and airway function (cough strength, sputum volume, signs of aspiration, airway structure) were collected. All patients underwent a standardized pre-decannulation assessment protocol, including fiberoptic bronchoscopy, a cuff-leak test, and a tube occlusion trial. Univariate analysis and multivariate logistic regression modeling were employed to identify factors independently associated with successful decannulation. RESULTS: Of the 156 patients, 89 (57.1%) were successfully decannulated. Multivariate logistic regression analysis identified the following independent protective factors for successful decannulation: a minimally conscious state (MCS) (OR = 5.58, 95% CI: 2.18–14.27), strong voluntary cough strength (OR = 5.21, 95% CI: 2.12–12.82), and daily sputum volume ≤ 30 mL (OR = 4.86, 95% CI: 2.02–11.70). CONCLUSION: Level of consciousness (minimally conscious state), cough strength, and sputum volume are key independent predictors of successful decannulation in patients with pDoC. An assessment pathway based on these indicators can help identify suitable candidates for decannulation, optimize clinical management strategies, and promote patient recovery and prognosis.