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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.

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