Frontiers in neurology · 2026
Decannulation criteria in patients with acquired brain injury based on interval forced vital capacity monitoring: a prospective observational study.
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Deng Yunhong, Wang Fuqiang, Li Yaojiang, Liang Jinfeng, Chen Hanbo, Xie Wenying, Fu Bizhou, Hao Man
Аннотация
OBJECTIVE: Optimized decannulation timing in tracheostomized patients with acquired brain injury (ABI) remains a significant clinical challenge. We examined the association between the 3-week change in forced vital capacity (FVC) and time to successful decannulation, including possible nonlinear threshold effects.
METHODS: This prospective observational cohort study enrolled 56 tracheostomized patients with ABI. FVC was measured at baseline (T0) and at 3 weeks (T1, ΔFVC = FVC_T1 - FVC_T0) using ATS/ERS-compliant spirometry. The primary outcome was time from T0 to successful decannulation (≥72 h without reintubation or reinsertion). Multivariable linear regression, generalized additive models, and threshold effect analysis were performed after adjustment for age, sex, disease duration, diagnosis, and hemiplegic side.
RESULTS: The cohort (N = 56; mean age 51.0 ± 7.6 years; 55.4% male) comprised cerebral infarction (44.6%), cerebral hemorrhage (33.9%), and traumatic brain injury (21.4%). In the adjusted linear model, each 1-L increase in ΔFVC was associated with 8.7 days shorter time to decannulation (β = -8.677 days/L, 95% CI: -12.399 to -4.955, p < 0.001). A threshold effect was identified at ΔFVC = 0.52 L: below this threshold, the association was pronounced (β = -13.616 days/L, p < 0.001); above it, the association was attenuated and non-significant (β = -2.244 days/L, p = 0.492).
CONCLUSION: Interval FVC monitoring may serve as a practical adjunct in decannulation assessment. A ΔFVC of 0.52 L or greater may serve as a clinically useful reference point for initiating comprehensive decannulation evaluation in patients with ABI undergoing pulmonary rehabilitation. This threshold should be interpreted cautiously and validated in larger multicenter studies.
METHODS: This prospective observational cohort study enrolled 56 tracheostomized patients with ABI. FVC was measured at baseline (T0) and at 3 weeks (T1, ΔFVC = FVC_T1 - FVC_T0) using ATS/ERS-compliant spirometry. The primary outcome was time from T0 to successful decannulation (≥72 h without reintubation or reinsertion). Multivariable linear regression, generalized additive models, and threshold effect analysis were performed after adjustment for age, sex, disease duration, diagnosis, and hemiplegic side.
RESULTS: The cohort (N = 56; mean age 51.0 ± 7.6 years; 55.4% male) comprised cerebral infarction (44.6%), cerebral hemorrhage (33.9%), and traumatic brain injury (21.4%). In the adjusted linear model, each 1-L increase in ΔFVC was associated with 8.7 days shorter time to decannulation (β = -8.677 days/L, 95% CI: -12.399 to -4.955, p < 0.001). A threshold effect was identified at ΔFVC = 0.52 L: below this threshold, the association was pronounced (β = -13.616 days/L, p < 0.001); above it, the association was attenuated and non-significant (β = -2.244 days/L, p = 0.492).
CONCLUSION: Interval FVC monitoring may serve as a practical adjunct in decannulation assessment. A ΔFVC of 0.52 L or greater may serve as a clinically useful reference point for initiating comprehensive decannulation evaluation in patients with ABI undergoing pulmonary rehabilitation. This threshold should be interpreted cautiously and validated in larger multicenter studies.