{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:59:04Z","timestamp":1780894744213,"version":"3.54.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Structured tracheostomy decannulation pathways specifically tailored to patients with prolonged disorders of consciousness (pDoC) after brain injury remain limited. We aimed to describe a stepwise decannulation pathway and evaluate its feasibility and safety in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed consecutive tracheostomized patients with pDoC after brain injury admitted to a single rehabilitation center. The pathway integrated flexible laryngoscopy for assessment of airway patency and secretion burden using the Murray Secretion Scale (MSS), assessment of airway protection using the Semi-quantitative Cough Strength Score (SCSS), and a monitored 48-h capping trial. The primary outcomes were feasibility (decannulation rate), early safety (reintubation or transfer to the ICU within 48\u202fh), and short-term safety (reintubation within 3\u202fmonths). Secondary outcomes included time from referral to decannulation, airway findings, and MSS grades on flexible laryngoscopy, SCSS score, and reasons for non-decannulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 61 included patients, 35 (57.4%) were successfully decannulated. No patient required reintubation or transfer to the ICU within 48\u202fh after decannulation. One patient underwent reintubation approximately 1\u202fmonth later because of severe liver failure rather than airway compromise. The mean time to decannulation was 19.8\u202f\u00b1\u202f8.2\u202fdays. Airway lesions were identified in 54 patients (88.5%), and 31 (50.8%) had MSS\u202f\u2265\u202f2. Twelve patients (19.7%) had SCSS &amp;lt; 3. The main barriers to decannulation were airway stenosis \u226550%, uncontrolled secretion burden, inadequate cough-mediated airway protection, and worsening pulmonary infection during capping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this single-center retrospective study, the stepwise decannulation pathway appeared feasible and was associated with favorable short-term safety outcomes in patients with pDoC after brain injury. The pathway may provide a structured framework for decannulation decision-making in this population. Further prospective, multicenter studies are needed to validate these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1841552","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:23:50Z","timestamp":1780892630000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A stepwise decannulation pathway for patients with prolonged disorders of consciousness after brain injury: a retrospective feasibility study"],"prefix":"10.3389","volume":"17","author":[{"given":"Jinjin","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Rehabilitation Medicine, the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Liu","sequence":"additional","affiliation":[{"name":"Fuzhou Neuropsychiatric Hospital Affiliated to Fujian Medical University","place":["Fuzhou, China"]},{"name":"Neuropsychiatric Prevention and Treatment Hospital of Fuzhou Second General Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyuan","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Rehabilitation Medicine, the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keling","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Rehabilitation Medicine, the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziza Abdulaziz","family":"Abdulwahid","sequence":"additional","affiliation":[{"name":"First Clinical Medical College, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Ni","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Rehabilitation Medicine, the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Rehabilitation Medicine, the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1212\/wnl.0000000000005926","article-title":"Practice guideline update recommendations summary: disorders of consciousness: report of the guideline development, 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