Barriers to Tracheostomy Weaning: A Case Report of Sialorrhea in a Patient with Persistent Seizure Activity and Head Injury

Thomas Amanda J,Hussain Z,Adshead B

doi:10.31579/2690-4861/197

Abstract

We describe a single case following the acute hospital journey of a 54 year old admitted due to seizure activity and associated traumatic brain injury. The patient was cared for in a specialist neurosurgical centre. The hospital stay was complicated by difficulty managing seizure activity. The patient had several failed extubations due to high oral secretion burden, resulting in a percutaneous tracheostomy. Prolonged tracheostomy weaning ensued due to the impact of seizure activity, pharmacological interventions to manage both seizure activity and secretion management (including the use of Botulinum Toxin to the salivary glands), and dysphagia. Successful decannulation of tracheostomy was achieved 141 days after insertion and was associated with a reduction in anti-epileptic drug administration.

Highlights

Sialorrhea is defined as excessive saliva or hyper-salivation commonly associated with drooling
There is a deficit of literature on the impact of excessive saliva production secondary to seizure activity on the tracheostomy weaning process
We present a single case of tracheostomy weaning which was excessively prolonged by the impact of seizure activity, pharmacological intervention to manage seizures, excessive oral secretion and dysphagia

Summary

Introduction

Sialorrhea is defined as excessive saliva or hyper-salivation commonly associated with drooling. There is a deficit of literature on the impact of excessive saliva production (or clearance) secondary to seizure activity on the tracheostomy weaning process. While management of sialorrhea with pharmaceutical agents such as anticholinergic drugs are often the first line approach, these have been associated with undesirable systemic effects due to inability to act on salivary gland receptors (7). They have been shown to affect the central nervous system, causing increased confusion, drowsiness and disorientation, which may be undesirable in the neurologically affected population [7].

Background

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Discussion

Conclusion